LSJE, LLC 6100 rs, Suite B-3, St. Thomas, VI 00802-1348 Phone: E-mail: [email protected] Subcontractor Employment Form Today's Date: Position/Title: Last Name: Nickname: Social Security Num Mailing Address: o021/1/02-O/q itives Cell Phone E-mail: In case of emergency, please contact Contact; ve_s Contact Phone Supervisor Notes: Start Date: Hourly Pay Rate: First Name: Date of Birth: 1y4 vid /02/051/417c2 Driver's License Number: ■ Physical Address: Phone (other): Marital Status: Relationship: Plarried \190 ktSe Proof of eligibility for employment is required. Please attach a.) a ohotocopv of your U.S. Passport or Passport Card OR b.) tam _ID...allawdottingslggstmentmlgagfls t Authorization Employee Signature: Supervisor Signature: Date: Date: EFTA01223506