EFTA00003054

LSJE, LLC 6100 Red I look Quarters Suite B-S St. Thomas, VI 00802 Tel: (:ontact urm Date: 03/20/18 Employee Name: (Amy litre Address: :A !homes VI 00802 Date of Birth: Start Date: Phone: Cell E-Mail: n/a Title / Position: Mathtenat.ce Marital Status: Married License: Illr4nergency Information: Allergies or Health Concerns. Blood Type: Current Medication: Doctor's Name: itc.: Il,,s I aiiiily Phone: Doctor's Name: Phone: In case of an Emergency, Please contact: Navin Valerie Relationship wife Phone /Sane Cierrycia Relationship Daughter Phone This Information is for your safety and the safety of others EFTA00003054