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LSJE, LLC

DOJ EFTA Data Set 10 document EFTA01342047

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DOJ EFTA Data Set 10 document EFTA01342047

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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Date: 06/08/18 Emergency Contact Form Employee Name: Cristobal Hidalgo Herrera Address: Boyoni 25C Phone: Position: hTigatio• Celt: Start Date: Date of Birth E-Mail: Marital Status License: r i'mergency information: Blood type unspecified Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: None Phone: Phone: In case of an Emergency, Please contact : Name g.- flame Villglo Herrera Relationship Brother Phone Relationship Phone This Information is for your safety and the safety of others EFTA01342047

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FaxFax: 340-775-8108
Phone340-775-8100
Phone340-775-8108

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LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: Date: 03/25/18 Employee Name: Pierre Jules Emergency Contact Form Fax: Start Date: Address: Date of Birth: Phone: Cell: E-Mail: n/a Title / Position: Operator Marital Status: Single License: i mergency Information: Allergies or Health Concern Blood Type: Current Medication: Doctor's Name: n a Phone: n a Doctor's Name: n/a Phone: n a In case of an Emergency, Please contact : Relationship Brother Pho

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