[[START OF PAGE 1]]

# LSJE,  LLC

6100Red Hook Quarters SuiteB-3St. Thomas, VI 00802Tel: 340-775-8100 Fax:340.775-8108

## Emergency Contact Form

Date: 04/10/18
Start Date: 05/04/17

Employee Name: James Cesar
Address: <empty>
Date of Birth: <empty>

Phone: <empty>
Cell: <empty>
E-Mail: <empty>

Title / Position: Carpenter
Marital Status: Married
License: <empty>

Emergency Informa tion:
Allergies or Health Ca ncer: No / Yes [ ] Specified
Blood Type: <empty>
Current Medication:
Doctor's Name: <empty>
Phone: <empty>
Doctor's Name: <empty>
Phone: <empty>

In case of an Emergency, Please contact :
Name Wisner Piern Relationship Phone
Name Alfred Piern Relationship Phone

ThisInformation isfor your safety and the safety of others

EFTA00003057

[[END OF PAGE 1]]
documents/EFTA00003057.pdf
{"people":["james cesar","wisner piern","alfred piern"]}