EFTA00003066

3 LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tcl: Fax: Date: 03/25/18 Employee Name: Pierre Jules Address: Phone Title / Position: Emergency Contact Form Start Date: Date of Birth E-Mail: n limergency Information: n a Allergies or Health Concerns: Bloo0 type unspecified Blood Type: I _ Current Medication: Doctor's Name: rVa Doctor's Name: n/a Phone: n/a Phone: we In case of an Emergency, Please contact: Relationship Brother Phone Relationship Friend Phone This Information is for your safety and the safety of others EFTA00003066