LSJE, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802 Tel: Date: NI 1/12 Employee Name: Randy Amparo Address: Phone: Title / Position: Boat Captain imergency Information: Allergies or Health Concerns: Blood Type: Emergency Contact Form Cell: Start Date: Date of Birth: Marital Status: Single License: Current Medication: Doctor's Name: Phone: Doctor's Name: Phone: In case of an Emergency, Please contact: Relationship AlitJame Relationship Father Mother This Information is for your safety and the safety of others EFTA00003067