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LS1E, LLC

DOJ EFTA Data Set 10 document EFTA01342061

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DOJ EFTA Data Set 10 document EFTA01342061

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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
LS1E, LLC Emergency Contact Form Date: 03/19/18 Employee Name: Leida >F eter Ca rnailMit Address: Phone: Title / Position: Housekeeping Cell: Start Date: Date of Birth: E-Mail: Marital Status: Married License: [ Allergies or Health Concerns: Blood type on form says "RhP", otherwise uspecified emergency Information: Blood Type: Current Medication: Doctor's Name: Coorbin Phone: Doctor's Name: Coorbin Phone: In case of an Emergency, Please contact : Name Porliriaortiz l arName Dransisco Hernandez Relationship Married Relationship Son Phone Phone This Information is for your safety and the safety of othe EFTA01342061

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