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# LSJE, LLC

6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348

Phone:

E-mail: thesaintjames.group@gmail.com

## Emergency Contact Form

Today's Date: 10/15/18
Start Date: <empty>
Employee Name: Carlos L Rodriguez
Date of Birth: <empty>
Physical Address: <empty> St Thomas, VI 00802
Mailing Address: 6501 Red Hook Plaza
Cell Phone: <empty>
Phone (other): <empty>
E-mail: <empty>
Marital Status: Married
Title/Position: Captain
Driver's License No: <empty>
Allergies or Health Concerns: <empty>
Blood type:
[ ] A-
[ ] A+
[ ] AB-
[ ] AB+
[ ] B-
[ ] B+
[ ] O-
[ ] O+
[x] Unknown
Current Medications: None
Doctor's Name: Dr. Livingston
Doctor's Phone: <empty>
Doctor's Name: <empty>
Doctor's Phone: <empty>
In case of emergency, please contact:
Name: <empty>
Relationship: Wife
Phone: <empty>
Name: <empty>
Relationship: <empty>
Phone: <empty>

Thisinformation is for yoursafety and the safetyof others.

EFTA00003045

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documents/EFTA00003045.pdf
{"people":["carlos rodriguez","dr. livingston"]}