LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 3 ; ‘ Emergency Contact Form Start Date: Date: 06/14/18 — Employee Name: Felito Joseph Address: PF Date of Birth: Marital Status: Single i s 3 Allergies or Health Concerns: ec: fa Current Medication: Doctor's Name: Phone: Doctor's Name: Phone: In case of an Emergency, Please contact : lame Jennifer Relationship —_Girlfriend Phone 3. ne Fay 5 Narr ay Relationship sister Phone This Information is for your safety and the safety of others EFTA00003052