EFTA01342059.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: Date: 03/16/18 Employee Name: Justine de la Cruz Address: Date of Birth: Phone: Cell: E-Mail: Title / Position: Housekeeper Marital Status: Married License: t tergency Information: NA Allergies or Health Concerns: Blood Type: ■ Current Medication: Doctor's Name: Phone: Doctor's Name: Phone: In case of an Emergency, Please contact : Name Feliz de la Cruz Relationship Husband Phone - 'lame Bembenido Gedeno Relationship Brother Phone This Information is for your safety and the safety of others EFTA01342059