Emergency Contact Form for Pierre Jules, LSJE LLC Employee

EMERGENCY CONTACT FORM

Company: LSJE, LLC Address: 6100 Red Hook Quarters Suite B-3, St. Thomas, VI 00802 Telephone and Fax: [REDACTED]

Date Completed: 03/25/18 Start Date: [BLANK]

Employee Information: - Name: Pierre Jules - Address: [REDACTED] - Date of Birth: [BLANK] - Phone: [REDACTED] - Cell: [BLANK] - E-Mail: n/a - Title/Position: Operator - Marital Status: Single - License: [BLANK]

Emergency Information: - Allergies or Health Concerns: Blood type unspecified - Blood Type: [BLANK] - Current Medication: [BLANK] - Doctor's Name: n/a - Doctor's Name: n/a - Phone: n/a - Phone: n/a

Emergency Contacts:

1. Name: [REDACTED], Relationship: Brother, Phone: [REDACTED]

2. Name: [REDACTED], Relationship: Friend, Phone: [REDACTED]

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

Names mentioned: - Pierre Jules — Employee working as Operator for LSJE, LLC; marital status listed as Single