EFTA Document EFTA01304183

I 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: 04/09/18 Start Date: Employee Name: Onel Pierresaint Address: Date of Birth: Phone: Cell: E-Mail: Title / Position: Marital Status: Married License: I nergency Information: Blood type unspecified Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: In case of an Emergency, Please contact : Name Rose Marie Jean Baptiste Relationship Wife Same Robenio Joseph Relationship Phone: Phone: Phone Friend Phone This Information is for your safety and the safety of others EFTA01304183