EFTA01304174

Extracted Text (OCR)

EFTA Disclosure

Text extracted via OCR from the original document. May contain errors from the scanning process.

8 LU 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 Employee Name: El!son B. Donissaint Address: 6043 Frydenhoi, St Thomas. VI 00802 Phone• 340-244 454: / mergency Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: Start Date: 04/10/18 Date of Birth: 04/06/1977 340-244-4541 E-Mail: [email protected] Marital Status: Married License: 1 B;r:od type not specified Phone: Phone: In case of an Emergency, Please contact : Name Angel Lundy Relationship Friend Relationship Phone Phone This Information is for your safety and the safety of others 340-626-8445 EFTA01304174

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Email[email protected]

FaxFax: 340-775-8108

Phone340-244-4541

Phone340-626-8445

Phone340-775-8100

Phone340-775-8108

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Dept. of JusticeOtherUnknown

EFTA Document EFTA01304174

8 LU 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 Employee Name: El!son B. Donissaint Address: 6043 Frydenhoi, St Thomas. VI 00802 Phone• 340-244 454: / mergency Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: Start Date: 04/10/18 Date of Birth: 04/06/1977 340-244-4541 E-Mail: [email protected] Marital Status: Married License: 1 B

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LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas. VI 00802 Tel: Emergency Contact Form 04:10/18 Employee Name: Dorn B. Donissaint Address: Tomas. VI 00802 Phone. Scslt‘Oi nereency Allergies or Health COMIKIll% Blood Type: Current Medication: Doctor's Name: Doctor's Name: Start Date: 04/10/18...

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