DOJ Epstein Files, Data Set 1 (EFTA00003048)

	Emergency Contact Form
Date: 04/10/18	04/10/18 Start Date:
Employee Name: Dalce Gusneme
Address:	Date of Birth:
Phone:	E-Mail: Cell:

Title / Position: Landspaping	License: Marital Status: Married
mergency Information:
Allergies or Health Concerns:	Blood type not specified
Blood Type:
Current Medication:

Doctor’s Name:	Phone:

Doctor’s Name:	Phone:
In case of an Emergency, Please contact :
Name ame	Relationship Phone Sister Relationship Phone