LSJE, LLC 6100 ers, Suite B-3, St. Thomas, VT 00802-1348 Phone E-mail: [email protected] Subcontractor Employment Form Today's Date: Start Date: Positionaitle: Hourly Pay Rate: 1 Last Name: First Name: LUCIA NE12. Nickname: Date of Birth: LaucisNeeK IMM Social Security Number: Mailing Address: Cell Phone: E-mail: In cast of emergency, please contact Contact: Contact Phone: Supervisor Notes: Driver's License Number: Physical Address: ■ Phone (other): Marital Status: Relationship: H W ice., Proof of eligibility for employment is required. Please attach a.)A photocopy of your U.S. Passport or Passoort Card OR b.) a photo ID AND suociortina documentation establishing U.S Employment Authorization Employee Signature: Supervisor Signature: Date: Date: EFTA01223009