EFTA01342047.pdf

EFTA01342047 LSJE, LLC Fax: 340-775-8108 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Emergency Contact Form Date: 06/08/18 Start Date: Employee Name: Cristobal Hidalgo Herrera Address: Boyoni 25C Date of Birth Phone: Celt: E-Mail: Position: hTigatio• Marital Status License: r i'mergency information: Blood type unspecified Allergies or Health Concerns: Blood Type: None Current Medication: Doctor's Name: Phone: Doctor's Name: Phone: In case of an Emergency, Please contact : Name Villglo Herrera Relationship Brother Phone g.- flame Relationship Phone This Information is for your safety and the safety of others