Employee Emergency Contact Form for Dale Mark - Incomplete
This is an incomplete emergency contact form from LSJE, LLC (a company located in St. Thomas, VI) dated 04/10/19. The form was filled out for employee Dale Mark but was marked 'Declined to complete,' suggesting the employee refused to provide full personal information. Most fields remain blank except for the employee name and date.
Document Transcript
LSJE, LLC Emergency Contact Form
Company: LSJE, LLC Address: 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 Email: thesaintjames.group@gmail.com Phone: [REDACTED]
Form Status: Marked 'Declined to complete'
Filled Fields: - Today's Date: 04/10/19 - Employee Name: Dale Mark - Start Date: [BLANK] - Date of Birth: [BLANK]
Unfilled Fields: - Physical Address: [BLANK] - Mailing Address: [BLANK] - Cell Phone: [BLANK] - Phone (other): [BLANK] - E-mail: [BLANK] - Marital Status: [BLANK] - Title/Position: [BLANK] - Driver's License No: [BLANK] - Allergies or Health Concerns: [BLANK] - Blood Type: [All options unchecked] - Current Medications: [BLANK] - Doctor's Name (1): [BLANK] - Doctor's Phone (1): [BLANK] - Doctor's Name (2): [BLANK] - Doctor's Phone (2): [BLANK] - Emergency Contact Name (1): [BLANK] - Emergency Contact Relationship (1): [BLANK] - Emergency Contact Phone (1): [BLANK] - Emergency Contact Name (2): [BLANK] - Emergency Contact Relationship (2): [BLANK] - Emergency Contact Phone (2): [BLANK]
Names mentioned: - Dale Mark — Employee for LSJE, LLC; declined to complete emergency contact form
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Type
OtherSource
DOJ - Data Set 1Release Date
January 24, 2025
Pages
1
File Size
479.0 KB
Format
Data Set
data-set-1
OCR Confidence
ID: EFTA00003036
Last updated: Apr 13, 2026
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