EFTA Document EFTA01304180

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: 04/10/18 Employee Name: James Cesar Address: Phone: Cell: E-Mail: Title / Position: Carpenter ilits-Amergency Info' ] n: Allergies or Hee Blood Type: Current Medication: Doctor's Name: Doctor's Name: In case of an Emergency, Please contact : Name Wisner Piern Relationship Start Date: 05/04/17 Date of Birth: Marital Status: Married License: I