EFTA01342065

3 LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: Fax: MI= Emergency Contact Form Date: 03/19/18 Employee Name: Patrick L. Cena Address: MIONIMIIIIIMMIIMilin Phone: Title / Position: Captain Amergency Information: Start Date: 02/05/18 Date of Birth: 04/01/75 Cell: E-Mail: Marital Status: License: Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: No blood type specified Phone: Phone: In case of an Emergency, Please contact : Name Pat & Emily Cena Relationship *ame Stephanie Remington Relationship Friend Phone Father/Stepmother Phone This Information is for your safety and the safety of others I • II I I it EFTA01342065