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# LSJE, LLC

6100 Red Hook Quarters Suite B-3 St. Thomas. VI 00802 Tel: 340-775-8100 Fax: 340-775-8108

## Emergency Contact Form

Date: 03/16/18
Start Date: <empty>

Employee Name: Justina de la Cruz
Address: <empty>
Date of Birth: <empty>

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

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

Emergency Information:

Allergies or Health Concerns: NA

Blood Type: <empty>

Current Medication: <empty>

Doctor's Name: <empty> 
Phone: <empty>

Doctor's Name: <empty> 
Phone: <empty>

## In case of an Emergency, Please contact:

Name: Feliz de la Cruz
Relationship: Husband
Phone:<empty>

Name: Bembenido Gedeno
Relationship: Brother
Phone:<empty>

This Information is for your safety and the safety ofothers

EFTA00003058

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documents/EFTA00003058.pdf
{"people":["justina de la cruz","feliz de la cruz"]}