LSJE, LLC
6100 Red I look Quarters, Suite 13-3, St. Thomas, VI 00802-1348
Phone: E-mail: thesaintjames.group@gmail.com
Emergency Contact Form
Today's Date:
1
10/21/18 Start Date:
Employee Name: Peter St Omer Date of Birth:
Physical Address:
Mailing Address:
Cell Phone: Phone (other):
E-mail: Marital Status: !Married
Title/Position: Operator Driver's license No:
as
Allergies or Health Concerns: N/A
Blood type:
Unknown
Current Medications:
Doctor's Name:
Doctors Phone:
Doctors Name:
Doctor's Phone:
In case of emergency, please contact
Name: kishma Relationship: Friend
Phone:
Name: 'Demers
Relationship: !Son Phone:
This information is for your safety
and the safety of others
EFTA00003065