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Case File
efta-01304162DOJ Data Set 10Other

EFTA01304162

Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01304162
Pages
1
Persons
0
Integrity

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Extracted Text (OCR)

EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
S Today's Date: Employee Name: Physical Address: Mailing Address: Cell Phone: Title/Position: LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas. VI 00802-1348 Phone: 340-775-2525 E-mail: [email protected] 11J,st,N. (J\--Ibut./6„ Start Date: Date of Birth: Emergency Contact Form \-J Phone (other): Marital Status: Driver's License No: Allergies or Health Concerns: Blood type: O A- F A+ Current Medications: AB+ B- O AB- NM B+ 0+ Doctor's Name: Doctor's Phone: Doctor's Name: Doctor's Phone: In case of emergency, please contact: Name: Relationship: Phone: Name: Relationship: Phone: K UnknowO Cy 1 J This information is for your safety and the safety of others. t 4 a EFTA01304162

Technical Artifacts (3)

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Email addresses, URLs, phone numbers, and other technical indicators extracted from this document.

Phone340-775-2525
Phone802-1348

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