📄 Extracted Text (103 words)
EFTA01304174
8
LU
LSJE, LLC
6100 Red Hook Quarters Suite B-3 St. Thomas,
VI 00802 Tel: 340-775-8100 Fax: 340-775-8108
Emergency Contact Form
Start Date: 04/10/18
Date: 04 10'18
Employee Name: El!son B. Donissaint
Address: 6043 Frydenhoi, St Thomas. VI 00802 Date of Birth: 04/06/1977
Phone• 340-244 454: 340-244-4541 E-Mail: [email protected]
/ Marital Status: Married License: 1
mergency
B;r:od type not 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 Angel Lundy Relationship Friend Phone 340-626-8445
Relationship Phone
This Information is for your safety and the safety of others
ℹ️ Document Details
SHA-256
3639c27588a897032888de45525b9869d73d334fdc1826d62c80ad90f6db5443
Bates Number
EFTA01304174
Dataset
DataSet-10
Document Type
document
Pages
1
Comments 0