EFTA_00 192983 LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: 340-775-8100 Fax: 340-775-8108 Emergency Contact Form Date: 04/10/18 Start Date: 04/10/18 Employee Name: Dalce Gusneme Address: Date of Birth: Phone: / Position: Marital Status: Married • • - mergency Informaik.;1: Allergies or Health Concerns: Blood Type: Current Medication: Doctor's Name: Doctor's Name: Blood type not specified Phone: Phone: In case of an Emergency, Please contact : Name Licimene Dalce *ame Relationship Sister Relationship E-Mail: Phone 340-344-1819 Phone This Information is for your safety and the safety of others EFTA01304172