EFTA01342069.pdf

LSJE, LLC 00802 Tel: 340-775-8100 Fax: 340-775-8108 6100 Red Hook Quarters Suite B-3 St. Thomas, VI Emergency Contact Form Start Date: 08/26/2018 Date: 09/10/18 Employee Name: Stephanie Remington Address: Date of Birth: Phone: Cell: E-Mail: ■ Title / Position: Asst to Manager Marital Status: Single License: l iergency Information: No allergies Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Phone: Doctor's Name: Phone: In case of an Emergency, Please contact : Name Patrick Cena Relationship Friend Phone l ame Drake Remington Relationship Phone This Information is for your safety and the safety of others EFTA01342069