EFTA01256961

LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tell: 340-775-8100 Fax: 340-775-8108 5 Date: 03 25 8 Employee Name: Pierre Jules Address: Phone: 340-998-9893 Title / Position: Operator I mergency Information: Emergency Contact Form Start Date: Date of Birth: Cell: E-Mail: n/a nia Allergies or Health Concerns: Blood type unspecified Blood Type: Current Medication: Marital Status: Single License: I Doctor's Name: n/a Phone: nia Doctor's Name: n/a Phone: n/a In case of an Emergency, Please contact : Name Bert Juies Relationship l a me Argentina Perez Brother Relationship Friend Phone Phone This Information is for your safety and the safety of others EFTA01256961