LSJE, LLC J rel: 775- Pax: -775-8108 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340 Emergency Contact Form Start Date: 05/04/17 Date: 4/10/18 hes _ Employee Name: James Cesar bien P| a ot a i Position: Carpente Marital Status: Married License: tle a Ghnergency Info Allergies or Hea’t Blood Type: Current Medication Doctor's Name: Phone: Doctor's Name: Phone: In case of an Emergency, Please contact : Name Wisner Piern Relationship Phone - gf ame Afred Pierr Relationship Phone This Information is for your safety and the safety of others EFTA00003057