EFTA Document EFTA01304179

LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: Date: 04/10/18 Employee Name: James Cesar Emergency Contact Form Start Date: 05/04/17 Address: Date of Birth: Phone: Cell: E-Mail: Title / Position: Ca, Marital Status: Married License: Allergies or Hc,a!ti Co, • • •-,t Blood Type: Current Medication: Doctor's Name: Doctor's Name: Phone: Phone: In case of an Emergency, Please contact : Name Wisner Piern Relationship t ame Afred Piern Relationship