EFTA00003063

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DOJ Data Set 1

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LSJE, LLC 
6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 
Date: 
03/19/18 
Employee Name: Oriole Joseph 
Address: 
Phon 
Title/ Position: Maintenance 
limergency Information: 
Allergies or Health Concerns: 
Blood Type: 
Current Medication: 
Doctor's Name: 
Doctor's Name: 
Emergency Contact Form 
Blood type unspecified 
Start Date: 
10/01/16 
Date of Birth 
E-Mail: 
Marital Status: Single 
License: 
Phone: 
Phone: 
In case of an Emergency, Please contact : 
Relationship 
Phone 
Relationship 
Cousin 
Phone 
This Information is for your safety and the safety of others 
EFTA00003063

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