EFTA00003049

LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 'H" Emergency Contact Form Date: 06/04/18 Employee Name: Danny Etienne Address: 'tvititE Title / Posit.:'i.: Ma • Start Date: Date of Birth: C tit E-Mail: Marital Status: Single License: Emergency Information: Allergies or Health Concerns: Blood Type: L Current Medication: Doctor's Name: Dodglas Phone: Doctor's Name: Dodglas Phone: In case of an Emergency, Please contact: Name Maria Relationship ame Relationship Etienne Phone Girlfriend Phone This Information is for your safety and the safety of others EFTA00003049