LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: me: ae Emergency Contact Form p /05/18 Date: 03/19/18 Start Date: 02 ‘ Employee Name: Patrick L. Cena Addvess: HE st¢ 201, st Thomas vi 00802 Date of Birth: Phone {iy cc Mai: Title / Position: Captain Marital Status: Divorce License: : rgency Information: No blood type specified Allergies or Health Concerns: Blood Type: | Current Medication: Doctor's Name: Phone: Doctor's Name: Phone: In case of an Emergency, Please contact : Name fF Relationship —_ Father/Stepmother Phone This Information is for your safety and the safety of others Relationship Friend Phone EFTA00003064