LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 fii: Emergency Contact Form Date: 03/19/18 Start Date: - ask. 1 —e 8 8€=— ove of sith il Phone: Cell P| E-Mail: Title / Position: Landscap: Marital Status: Single License: | ns ! : \ Employee Name: Gael J Leatham | | - _ oy — Information Allergies or Health Concerns: a eat S| | 1 \ Current Medication: Doctor's Name: Phone: | Doctor's Name: Phone: In case of an Emergency, Please contact : Relationship Girlfriend Phone faaime PF Relationship Sister Phone This Information is for your safety and the safety of others EFTA00003053