Emergency Contact Form for LSJE, LLC Employee

LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 Phone: [REDACTED] | E-mail: thesaintjames.group@gmail.com

--- EMERGENCY CONTACT FORM ---

Today's Date: 2/6/19 Start Date: [BLANK] Employee Name: Sheraton Sizer [handwritten] Date of Birth: [REDACTED]

Physical Address: [REDACTED] Mailing Address: [BLANK]

Cell Phone: [REDACTED] Phone (other): [REDACTED] E-mail: [REDACTED] Marital Status: [BLANK]

Title/Position: [BLANK] Driver's License No: [BLANK]

Allergies or Health Concerns: [BLANK] Blood type: [Checkbox options: A-, A+, AB-, AB+, B-, B+, O-, O+, Unknown - all unchecked]

Current Medications: [BLANK]

Doctor's Name: [BLANK] | Doctor's Phone: [BLANK] Doctor's Name: [BLANK] | Doctor's Phone: [BLANK]

In case of emergency, please contact: Name: [REDACTED] | Relationship: Wife [handwritten] | Phone: [REDACTED] Name: [BLANK] | Relationship: [BLANK] | Phone: [BLANK]

Footer: "This information is for your safety and the safety of others."

Bates Number:

Names mentioned: - Sheraton Sizer — Employee for LSJE, LLC; handwritten entry on emergency contact form - [REDACTED] — Emergency contact listed as 'Wife' of employee