EFTA00003036.pdf
479 KB
Extraction Summary
1
People
2
Organizations
1
Locations
1
Events
1
Relationships
1
Quotes
Document Information
Type:
Hr form / emergency contact form
File Size:
479 KB
Summary
An Emergency Contact Form for LSJE, LLC dated April 1, 2019, for an employee named Dale Mark. The document header indicates the employee 'Declined to complete' the form, leaving all personal contact, medical, and emergency contact fields blank. The document lists the company address in St. Thomas, USVI.
People (1)
| Name | Role | Context |
|---|---|---|
| Dale Mark | Employee |
Name listed on the employee form; declined to complete the rest of the information.
|
Organizations (2)
| Name | Type | Context |
|---|---|---|
| LSJE, LLC |
Company letterhead on the form.
|
|
| The Saint James Group |
Implied by the email address 'thesaintjames.group@gmail.com'.
|
Locations (1)
| Location | Context |
|---|---|
Key Quotes (1)
"Declined to complete."Source
EFTA00003036.pdf
Quote #1
Full Extracted Text
Complete text extracted from the document (919 characters)
Declined to complete.
LSJE, LLC
6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348
Phone: [REDACTED] E-mail: thesaintjames.group@gmail.com
6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348
Phone: [REDACTED] E-mail: thesaintjames.group@gmail.com
Emergency Contact Form
Today's Date: 04/01/19
Start Date: [BLANK]
Employee Name: Dale Mark
Date of Birth: [BLANK]
Start Date: [BLANK]
Employee Name: Dale Mark
Date of Birth: [BLANK]
Physical Address: [BLANK]
Mailing Address: [BLANK]
Mailing Address: [BLANK]
Cell Phone: [BLANK]
Phone (other): [BLANK]
E-mail: [BLANK]
Marital Status: [BLANK]
Title/Position: [BLANK]
Driver's License No: [BLANK]
Phone (other): [BLANK]
E-mail: [BLANK]
Marital Status: [BLANK]
Title/Position: [BLANK]
Driver's License No: [BLANK]
Allergies or Health Concerns: [BLANK]
Blood type:
[ ] A- [ ] A+ [ ] AB- [ ] AB+ [ ] B- [ ] B+ [ ] O- [ ] O+ [ ] Unknown
[ ] A- [ ] A+ [ ] AB- [ ] AB+ [ ] B- [ ] B+ [ ] O- [ ] O+ [ ] Unknown
Current Medications: [BLANK]
Doctor's Name: [BLANK]
Doctor's Phone: [BLANK]
Doctor's Name: [BLANK]
Doctor's Phone: [BLANK]
Doctor's Phone: [BLANK]
Doctor's Name: [BLANK]
Doctor's Phone: [BLANK]
In case of emergency, please contact:
Name: [BLANK] Relationship: [BLANK] Phone: [BLANK]
Name: [BLANK] Relationship: [BLANK] Phone: [BLANK]
Name: [BLANK] Relationship: [BLANK] Phone: [BLANK]
Name: [BLANK] Relationship: [BLANK] Phone: [BLANK]
This information is for your safety and the safety of others.
EFTA00003036
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