Case File
efta-efta00003048DOJ Data Set 1CorrespondenceEFTA00003048
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Unknown
Source
DOJ Data Set 1
Reference
efta-efta00003048
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LSJE, LLC
6100 Red [look Quarters Suite B-3 St. Thomas, VI 00802 Tel:
ax:
)4'10/18
Employee Name: Deice Gusneme
Address:
Phone:
le / Position-
..—
L:41.
ZIF.mergeocy Informal it
Allergies or Health Concerns:
Blood Type:
Current Medication:
Emergency Contact Form
Start Date:
Date of Birth:!
E-Mail:
Marital Status: Married
License:
Blood type not specified
Doctor's Name:
Pho►re:
Doctor's Name:
Phone:
In case of an Emergency, Please contact :
Relationship
Sister
Phone
Relationship
Phone
This Information is for your safety and the safety of others
EFTA00003048
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