EFTA01342058

A LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: Date: Emergency Contact Form 04/10/18 Start Date: 05/04/17 Employee Name: James Cesar Address: Phone: Title / Position: Carpenter l mergency Info' • Allergies or Hea't . Blood Type: Current Medication: Doctor's Name: Doctor's Name: Cell: In case of an Emergency, Please contact : Name Wisner Piern Relationship 44*.arne Afred Piem Relationship Marital Status: Phone: Phone: Date of Birth: E-Mail: License: LLZ C Phone Phone This Information is for your safety and the safety of others EFTA01342058