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{
    "localId": "2661767",
    "label": "Kloman, Agnes Picket",
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    "citationUrl": "https://catalog.archives.gov/id/2661767"
}

{
    "id": "2661767",
    "sourceUrl": "https://catalog.archives.gov/id/2661767",
    "contentType": "document",
    "title": "Kloman, Agnes Picket",
    "citationUrl": "https://catalog.archives.gov/id/2661767",
    "collections": [
        "Records of the American National Red Cross",
        "Historical Nurse Files"
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{
    "url": "https://catalog.archives.gov/id/2661767",
    "naId": 2661767,
    "coverageEndDate": {
        "day": 17,
        "logicalDate": "1948-03-17",
        "month": 3,
        "year": 1948
    },
    "coverageStartDate": {
        "day": 17,
        "logicalDate": "1918-04-17",
        "month": 4,
        "year": 1918
    },
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    "recordType": "description",
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{
    "seq": 93,
    "pageIndex": 0,
    "type": "photo",
    "url": "https://s3.amazonaws.com/NARAprodstorage/lz/partnerships/40033/0001/DCD00073/40033_2421406259_0469/40033_2421406259_0469-00331.jpg",
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    "ocrText": "K\nA\nForm'No. 200\nQUINTUPLICATE\n9\nRevised 2-15-18\nAMERICAN RED CROSS\nNo.\nSERVICE ENROLLMENT APPLICATION\nDate\n(OTHER THAN AS DOCTOR, SURGEON, OR NURSE)\nghese\n5\nrb\ns\nThe questions should be answered as fully as possible, especially when an application for a passport may later be necessary.\nAll answers must be in handwriting of applicant.\n1. Name in full Agnes Pickett Kloman, R.N.\nTelephone No. 866\n2. Present Address. 915--2nd Ave. South, Fargo., N.D\n(Number and Street)\n(City)\n(State)\n(a) If any changes of residence since August I, 1914, give these in full with dates.\nCharles Street, Ave Station N, Baltimore, Md, Sent. 1st 1916\n(b) What is your present business or profession? (Be specific.)\n(c) What previous business or professional experience have you had, stating nature, places and principal dates\nSchool nurse, Medical inspection of Schoola, in Frago\nthereof? Assistant Supt, of Nurses, Union Protestant Infirmary, Balto, Md.\n9 months. School nurse in Balto, Md, for 5 years. 1910 toG1915\nSchool nurse Fargo, N.D. 1916 to 1918\n(d) Have you ever lived in Europe? If so, give names of European countries in which you have resided\nand respective dates of residence in each.\nNo\n(e) Have you ever traveled in Europe? If so, name countries visited, with respective dates of visits.\n(f) Since August Mo I, 1914, have you applied for a United States passport? If so, state whether application\nwas granted, denied or withdrawn.\nHave not applied\n3. State fully your participation in war service of U. S., or any of Allies or of enemy, or in that of any state militia\n(a) Have you ever been examined for war service? If so, state when, where and, if possible, name of examin-\ning official.\nyes., Dra Wm, Nichols, Fargo, N.D. April 1918\n(b) Were you accepted, rejected, or is result of examination pending?\nAccepted\n4. Date of birth 1874\nJanuary.,\n4th\n(a) Place of birth Warrenton, Va\nYear\nMonth\nDay\n(b) Full name of father Edward Felix Kloman,\n(c) Birthplace of fatherBaltimore, Md.\n(d) Nationality of father American\n(e) If father foreign born, whether naturalized and when\n(f) Full maiden name of mother. Agnes Pickett Helm\n(g) Birthplace of mother Warrenton, Va.\n(h) Nationality of mother. American\n(i) If mother foreign born, whether naturalized and when\n(j) Full name and nationality of paternal grandfather. Edward Felix Kloman, Dutch & French\n(k) Full maiden name and nationality of paternal grandmother Wilhelmina Brydon, Dutch & French\n(1) Full name and nationality of maternal grandfather Erasnus Helm, American\n(n) Names of all relatives nearer than second cousins living in Europe, specifying which of said relatives,\n(m) Full maiden name and nationality of maternal grandmother Virginia Asquith, American\nif\nany, are now or have been in the war service of Germany, Austria, Bulgaria or Turkey. State\nnature and places of employment of each of such relatives not now in such war service.\nNone, ( for which I am most thankful)\n(o) Names of all relatives nearer than second cousins in the war service of any of the allies of the United States,\nspecifying which ally in every case.\nNone"
}