EFTA Document EFTA01304181

3 LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Date: 03/16/18 Employee Name: Justina de la Cruz Address: Phone: Emergency Contact Form Title / Position: Housekeeper Cell: Start Date: Date of Birth: E-Mail: Marital Status: Married License: ergency Information: Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: NA Phone: Phone: In case of an Emergency, Please contact : Name Feliz de la Cruz Relationship lame Bembenido Gedeno Relationship Husband Brother Phone Phone This Information is for your safety and the safety of others of • I EFTA01304181