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