EFTA01342054

r 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 • LSJE, LLC Emergency Contact Form Date: 03/19/18 Start Date: Employee Name: Gael J Leatham Address: Date of Birth Phone: Cell: E-Mail: Title / Position: Lamiscapirig Marital Status: Single License: e"N t ergency Information: Allergies or Health Concerns: Blood Type: 0+ Current Medication: Doctor's Name: Doctor's Name: Phone: Phone: LL2 C In case of an Emergency, Please contact : Name Kendra Daniel ,LA . Sophie Happar Relationship Girlfriend Relationship Sister Phone Phone This Information is for your safety and the safety of others EFTA01342054