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sd-10-EFTA01304172Dept. of JusticeOther

EFTA Document EFTA01304172

EFTA_00 192983 LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Emergency Contact Form Date: 04/10/18 Start Date: 04/10/18 Employee Name: Dalce Gusneme Address: Date of Birth: Phone: / Position: Marital Status: Married • • - mergency Informaik.;1: Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: Blood type not specified Phone: Phone: In case of an Emergency, Please contact :

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Dept. of Justice
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sd-10-EFTA01304172
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EFTA_00 192983 LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Emergency Contact Form Date: 04/10/18 Start Date: 04/10/18 Employee Name: Dalce Gusneme Address: Date of Birth: Phone: / Position: Marital Status: Married • • - mergency Informaik.;1: Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: Blood type not specified Phone: Phone: In case of an Emergency, Please contact :

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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
EFTA_00 192983 LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Emergency Contact Form Date: 04/10/18 Start Date: 04/10/18 Employee Name: Dalce Gusneme Address: Date of Birth: Phone: / Position: Marital Status: Married - mergency Informaik.;1: Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: Blood type not specified Phone: Phone: In case of an Emergency, Please contact : Name Licimene Dalce *ame Relationship Sister Relationship E-Mail: Phone 340-344-1819 Phone This Information is for your safety and the safety of others EFTA01304172

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FaxFax: 340-775-8108
Phone340-344-1819
Phone340-775-8100
Phone340-775-8108

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