EFTA01304176.pdf

EFTA01304176 LSJE, LLC 340-775-8100 Fax: 340-775-8108 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: Emergency Contact Form Date: 03/19/18 Start Date: Employee Name: Gael J Leatham Address: 10-9 Estate Manendahl Date of Birth Phone: Cell: E-Mail: Title / Position: Landscapi,.g Marital Status: Single License: LL 1 ergency Information: Allergies or Health Concerns: LL Blood Type: O+ 2 Current Medication: C Doctor's Name: Phone: Doctor's Name: Phone: In case of an Emergency, Please contact : Name Kendra Daniel Relationship Girlfriend Phone me Sophie Happar Relationship Sister Phone This Information is for your safety and the safety of others