EFTA00003069

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: 09/10/18 Start Date: 08/26/2018 Employee Name: Stephanie Remington Address: Phone: Title / Position: Asst to Manager Slergency Information: Allergies or Health Concerns: Blood Type: Current Medication: 18-1-3 Estate Smith Bey 00002 Cell: E-Mail: Marital Statu,, single License: Doctor's Name: Island Health 8, Wellness Center Phone Doctor's Name: In case of an Emergency, Please contact: Relationship Relationship Phone: Enema ''hone l'none This Information is for your safety and the safety of others EFTA00003069