EFTA01342057

"ame Afred Piern LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: Date: 04/10/18 Employee Name: James Cesar Address: Phone: Title / Position: Cal zmergency Info! r Allergies or Hea'ti- ' Blood Type: Current Medication: Doctor's Name: Doctor's Name: Emergency Contact Form Cell: Marital Status: f: fled Phone: Phone: In case of an Emergency, Please contact : Name Wisner Piern Relationship Relationship Fax: Start Date: 05/04/17 Date of Birth: E-Mail: License: Phone Phone This Information is for your safety and the safety of others L III EFTA01342057