Emergency Contact Form for Sylvester Gaillard, LSJE LLC

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: 01/11/18 Start Date: [BLANK]

Employee Name: Sylvester Gaillard Date of Birth: [REDACTED]

Physical Address: [REDACTED], St Thomas, VI Mailing Address: [REDACTED], St Thomas, VI

Cell Phone: [REDACTED] Phone (other): [BLANK]

E-mail: [BLANK] Marital Status: Single

Title/Position: Supervisor Driver's License No: [REDACTED]

Allergies or Health Concerns: None

Blood type: [REDACTED]

Current Medications: Diabetic Medications

Doctor's Name: Dr. Alah Doctor's Phone: [BLANK]

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

In case of emergency, please contact:

Name: [REDACTED] Relationship: Mother Phone: [REDACTED]

Name: [BLANK] Relationship: [BLANK] Phone: [BLANK]

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

Names mentioned: - Sylvester Gaillard — Employee, Supervisor at LSJE LLC - Dr. Alah — Employee's physician