LSJE, LLC 6100 Red [look Quarters Suite B-3 St. Thomas, VI 00802 Tel: ax: Date: )4'10/18 Employee Name: Deice Gusneme Address: Phone: le / Position- ..— L:41. ZIF.mergeocy Informal it Allergies or Health Concerns: Blood Type: Current Medication: Emergency Co

LSJE, LLC 6100 Red [look Quarters Suite B-3 St. Thomas, VI 00802 Tel: ax: Date: )4'10/18 Employee Name: Deice Gusneme Address: Phone: le / Position- ..— L:41. ZIF.mergeocy Informal it Allergies or Health Concerns: Blood Type: Current Medication: Emergency Co

LSJE, LLC 6100 Red [look Quarters Suite B-3 St. Thomas, VI 00802 Tel: ax: Date: )4'10/18 Employee Name: Deice Gusneme Address: Phone: le / Position- ..— L:41. ZIF.mergeocy Informal it Allergies or Health Concerns: Blood Type: Current Medication: Emergency Co