Employee Emergency Contact Form for James Cesar, Carpenter

EMERGENCY CONTACT FORM

Company: LSJE, LLC Address: 6100 Red Hook Quarters Suite B-3, St. Thomas, VI 00802 Telephone: 340-775-8100 Fax: 340-775-8108

Form Date: 04/10/18 Start Date: 05/04/17

Employee Name: James Cesar Address: [REDACTED] Date of Birth: [REDACTED] Phone: [REDACTED] Cell: [not completed] E-Mail: [REDACTED]

Title/Position: Carpenter Marital Status: Married License: [blank]

Emergency Information: Allergies or Health Conditions: [partially obscured] Blood Type: [blank] Current Medication: [blank]

Doctor's Name: [blank] Phone: [blank]

Doctor's Name: [blank] Phone: [blank]

In case of an Emergency, Please contact:

1. Name: Werner Piern Relationship: [blank] Phone: [REDACTED]

2. Name: Alfred Piern Relationship: [blank] Phone: [REDACTED]

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

Names mentioned: - James Cesar — Employee; Carpenter at LSJE, LLC; employed starting 05/04/17 - Werner Piern — Listed as emergency contact (relationship not specified) - Alfred Piern — Listed as emergency contact (relationship not specified)