Employee Emergency Contact Form for Keshaun Williams, Engineer

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: 08/25/18 Start Date: 10/01/18 Employee Name: Keshaun Williams Date of Birth: [REDACTED]

Physical Address: [BLANK] Mailing Address: [BLANK] Cell Phone: [REDACTED] Phone (other): [BLANK] E-mail: [REDACTED] Marital Status: [BLANK] Title/Position: Engineer Driver's License No: [BLANK]

Allergies or Health Concerns: N/A Blood type: [REDACTED] 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: Mom Phone: [REDACTED]

Name: [REDACTED] Relationship: Friend Phone: [REDACTED]

This information is for your safety and the safety of others.

Names mentioned: - Keshaun Williams — Employee, Engineer at LSJE, LLC, hired 10/01/18