EPSTEIN
page 8 / 717 . OCR, unverified
EFTA01342060
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LS1E, LLC
Emergency Contact Form
Date:
03/19/18
Employee Name: Leida >F eter
Ca rnailMit
Address:
Phone:
Title / Position: Housekeeping
Cell:
Start Date:
Date of Birth:
E-Mail:
Marital Status: Married
License: [
Allergies or Health Concerns: Blood type on form says "RhP", otherwise uspecified
emergency Information:
Blood Type:
Current Medication:
Doctor's Name:
Coorbin
Phone:
Doctor's Name:
Coorbin
Phone:
In case of an Emergency, Please contact :
Name Porliriaortiz
l arName
Dransisco Hernandez
Relationship
Married
Relationship
Son
Phone
Phone
This Information is for your safety and the safety of othe
EFTA01342061
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a
6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel:
Emergency Contact Form
Date:
06/14/18
Address:
Phone:
Cell:
Title / Position: Engineer
i nergency Information:
Allergies or Health Concerns:
Blood Type:
O-
None
None
Employee Name: Michael J Glidden
Start Date:
04/20/18
Date of Birth: IM
E-Mail:
Marital Status:
License:
Current Medication:
Doctor's Name:
Phone:
Doctor's Name:
Phone:
In case of an Emergency, Please contact :
Name
Tanner Glidden
Relationship
■
lame
Robert Glidden
Relationship
Phone
Phone
This Information is for your safety and the safety of others
EFTA01342062
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LS E LLC
Emergency Contact Form
Date:
04/09/18
Employee Name: Onel Pierresaint
Address:
Phone:
Title / Position:
I
nergency Information:
Blood type unspecified
Allergies or Health Concerns:
Losartan Potassium 50 mg Tab
Doctor's Name:
Rosal Joselito
Doctor's Name:
In case of an Emergency, Please contact :
Start Date:
Date of Birth:■
E-Mail:
Marital Status: Married
License: L
Phone:
Phone:
Name
Rose Marie Jean Baptiste
Relationship
Wife
Phone
glI3 me
Robenio Joseph
Relationship
Friend
Phone
This Information is for your safety and the safety of others
EFTA01342063
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LSJE, LLC
6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel:
Date:
03/19/18
Employee Name: Oriole Joseph
Address:
Kronpreusens Grade
Phone:
Title / Position: Maintenance
mergency Information:
Allergies or Health Concerns.
Blood Type:
Current Medication:
Doctor's Name:
Doctor's Name:
Emergency Contact Form
Cell:
In case of an Emergency, Please contact :
Name
'lame
Relationship
Relationship
Marital Statu
Phone:
Phone:
Fax:
Start Date:
10/01/16
Date of Birt
E-Mail:
License:
Cousin
Phone
Cousin
Phone
This Information is for your safety and the safety of others
EFTA01342064
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LSJE, LLC
6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel:
Fax: MI=
Emergency Contact Form
Date:
03/19/18
Employee Name: Patrick L. Cena
Address:
MIONIMIIIIIMMIIMilin
Phone:
Title / Position: Captain
Amergency Information:
Start Date:
02/05/18
Date of Birth: 04/01/75
Cell:
E-Mail:
Marital Status:
License:
Allergies or Health Concerns:
Blood Type:
Current Medication:
Doctor's Name:
Doctor's Name:
No blood type specified
Phone:
Phone:
In case of an Emergency, Please contact :
Name
Pat & Emily Cena
Relationship
*ame
Stephanie Remington
Relationship
Friend
Phone
Father/Stepmother
Phone
This Information is for your safety and the safety of others
I
•
II
I
I
it
EFTA01342065
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Today's Date:
Employee Name:
Physical Address:
LSJE, LLC
6100 Red Hook Quarters, Suite n
Ct Thntmic VI
Phone: 340-775-2525
E-mail:
110/21/18
Peter St Omer
Mailing Address:
Cell Phone:
E-mail:
Title/Position:
Operator
Allergies or Health Concerns:
N/A
Emergency Contact Form
Blood type:
ri A-
K A+
D AB-
El AB
Current Medications:
Doctor's Name:
Doctor's Name:
In case of emergency, please contact:
Name: Kishma
Name: [Demitri
Start Date:
Date of Birth:
Phone (other):
Marital Status:
Driver's License No:
B-
K B+
Friend
Doctor's Phone:
Doctor's Phone:
Relationship:
Relationship:
E 0+
K Unknown
Phone:
Phone:
This information is for your safety and the safety of others.
EFTA01342066
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