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d-5244Dept. of JusticeOther

40 Coyvtle e [EFTA00003039]

Date
December 19, 2025
Source
Dept. of Justice
Reference
EFTA 00003039
Pages
2
Persons
3

Summary

40 Coyvtle e Today's Date: Employee Name: Physical Address: Mailing Address: Cell Phone: E-mail: Title/Position: LSJE, LLC ers, Suite 8-3, St. Thomas, VI 00802-1348 Phone: E-mail: thesaintjames.group@gmail.com Emergency Contact Form Aiicitoias Vir4vitt Start Date: Date of Birth: Phone (other): Ma...

This document is from the DOJ EFTA Releases (OCR).

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Persons Referenced (3)

Thomas, VIJamesUnknown

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efta
Browse DOJ EFTA Releases (OCR)EFTA 00003039
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Extracted Text (OCR)

EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
N•R 
C 
Al 
Cu 
Dc 
Dc 
In ( 
Nar 
;Aar 
-Dec 
40 Coyvtle e 
Today's Date: 
Employee Name: 
Physical Address: 
Mailing Address: 
Cell Phone: 
E-mail: 
Title/Position: 
LSJE, LLC 
6100 
ers, Suite 8-3, St. Thomas, VI 00802-1348 
Phone: 
E-mail: thesaintjames.group@gmail.com 
Emergency Contact Form 
Aiicitoias Vir4vitt 
Start Date: 
Date of Birth: 
Phone (other): 
Marital Status: 
Driver's License No: 
Allergies or Health Concerns: 
Blood type: 
A- 
D A+ 
K AB- 
O AB+ 
K B- 
O El+ 
D 0- 
E 0+ 
D Unknown 
Current Medications: 
Doctors Name: 
Doctor's Name: 
Doctor's Phone: 
Doctor's Phone: 
in case of emergency, please contact: 
Name, 
Name: 
Rclationahip. 
Relationship: 
Phone: 
Phone: 
This information is for your safety and the safety of others. 
EFTA00003039

--- Page Break ---

N•R 
C 
Al 
Cu 
Dc 
Dc 
In ( 
Nar 
;Aar 
-Dec 
40 Coyvtle e 
Today's Date: 
Employee Name: 
Physical Address: 
Mailing Address: 
Cell Phone: 
E-mail: 
Title/Position: 
LSJE, LLC 
6100 
ers, Suite 8-3, St. Thomas, VI 00802-1348 
Phone: 
E-mail: thesaintjames.group@gmail.com 
Emergency Contact Form 
Aiicitoias Vir4vitt 
Start Date: 
Date of Birth: 
Phone (other): 
Marital Status: 
Driver's License No: 
Allergies or Health Concerns: 
Blood type: 
A- 
D A+ 
K AB- 
O AB+ 
K B- 
O El+ 
D 0- 
E 0+ 
D Unknown 
Current Medications: 
Doctors Name: 
Doctor's Name: 
Doctor's Phone: 
Doctor's Phone: 
in case of emergency, please contact: 
Name, 
Name: 
Rclationahip. 
Relationship: 
Phone: 
Phone: 
This information is for your safety and the safety of others. 
EFTA00003039

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LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas. VI 00802-1348 Phone: E-mail: thesaintjames.group@email.com Emergency Contact Form Today's Date: Employee Name: Physical Address: Mailing Address: Cell Phone: E-mail: Title/Position: Start Date: Date of Birth: [IStimn 6.11‘tv.tss 0,..b €)040...

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.1) tclz AAP 40 [EFTA00003040]

.1) tclz AAP 40 LSJE, LLC 6100 Red Hook uarters, Suite B-3. St. Thomas. VI 00802-1348 Phone: E-mail: thesaintjames.grop@gmail.com Emergency Contact Form Today's Date: Employee Name: Physical Address: Mailing Address: Cell Phone: E-mail: Title/Position: Start Date: Date of Birth: Phone (other): Ma...

2p

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