LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 Phone: 340-775-2525 E-mail: [email protected] Subcontractor Employment Form Today's Date: Position/Title: Start Date: Hourly Pay Rate: 0.21/1/O2-0/q 2/4,4? Last Name: Nickname: Social Security Number. Mailing Address: LA-)Yes Cell Phon E-mail: In case of emergency, please contact Contact: She)); Veis Contact Phone: Supervisor Notes: First Name: Date of Birth: 1\e4vid /02/051/4 9 Driver's License Number: Physical Address: Phone (other): Marital Status: Relationship: 7/larded \3,420 Hsi Proof of eligibility for employment is required. Please attach a.) a Photocopy of your U.S. Passport or Passport Card OR b.) a photo ID AND supporting documentation establishino US. Employment Authorizatign Employee Signature: Supervisor Signature: Date: Date: oeL74-0 7 AilvA EFTA01223493