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QUINTUPLICATE
Form No. 200
Revised 5-15-18
AMERICAN RED CROSS
SERVICE APPLICATION FORM
Applicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus
of the American Red Cross
These questions must be answered fully or the application will not be acted upon
Date
August 29, 1048.
1. Name in full Elizabeth Gertrude "ilson
Telephone No. Schenley 3590
2. Permanent
Address 155 N. Craig Street. Pittsburgh Penna.
(Number and Street)
(City)
(State)
3. Temporary Address, if any, to what date none
(Number and Street)
(City)
(State)
4. (a) If any changes of residence since August 1, 1914, give these in full with dates 7030 Montecelle St.
March 1917.
414 Arch St. March 1918 800 Arch St. May 1018.
(b) What is your present business or profession ? Nursing
Name of firm or corporation with which associated none
Duration of Service
non e
Present Capacity nursing
Business Address 155 No. Craig St. Pittsburgh Penna.
(Number and Street)
(City)
(State)
5. Date of Birth 1879
Feb
17
(a) Place of Birth
Brookville Pa.
(Year)
(Month)
(Day)
(b) If of foreign birth, when and where did you arrive in the United States?
American
6. If foreign born, give date and court of your naturali ation
7. (a) Single, married or widower
Single
(a) Number of Dependents none
(b) Full name of wife before marriage; or husband Single
(c) Birthplace of wife or husband Single
Nationality of wife or husband
Single
(d) Birthplace and nationality of father of wife or husband
(e) Birthplace and nationality of mother of wife or husband
Single
(f) Full name of father
Cyrus Butler Wilson
(g)
Birthplace and nationality of father Brookville Jefferson Co. Penna
American
(h) If father foreign born, whether naturalized, when and where Ame orican Born
(i) Full maiden name of mother
Anna ForKum
(j) Birthplace and nationality of mother Sligo Clarion Co, Penna
(k) If mother foreign born, whether naturalized, when and where American Born
(1) Full name and nationality of paternal grandfather Wm. ForKum American
(m) Full maiden name and nationality of paternal grandmother Kathryn Jabe Moody
(n) Full name and nationality of maternal grandfather
Enock H. Wilson
(o)
Full maiden name and nationality of maternal grandmother
Elizabeth Butler
8. (a) What previous business or professional experience have you had, stating nature, places and principal
dates thereof; the names of the firms or corporations with which you were associated
Engaged in Private Nursing.
Page data
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- Source index
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- Type
- photo
- Media ID
- cc439741c4f0022e
- Size
- unknown
Document data
- ID
- 2661987
- Core
- doc
- Type
- document
DTO data
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"ocrText": "QUINTUPLICATE\nForm No. 200\nRevised 5-15-18\nAMERICAN RED CROSS\nSERVICE APPLICATION FORM\nApplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus\nof the American Red Cross\nThese questions must be answered fully or the application will not be acted upon\nDate\nAugust 29, 1048.\n1. Name in full Elizabeth Gertrude \"ilson\nTelephone No. Schenley 3590\n2. Permanent\nAddress 155 N. Craig Street. Pittsburgh Penna.\n(Number and Street)\n(City)\n(State)\n3. Temporary Address, if any, to what date none\n(Number and Street)\n(City)\n(State)\n4. (a) If any changes of residence since August 1, 1914, give these in full with dates 7030 Montecelle St.\nMarch 1917.\n414 Arch St. March 1918 800 Arch St. May 1018.\n(b) What is your present business or profession ? Nursing\nName of firm or corporation with which associated none\nDuration of Service\nnon e\nPresent Capacity nursing\nBusiness Address 155 No. Craig St. Pittsburgh Penna.\n(Number and Street)\n(City)\n(State)\n5. Date of Birth 1879\nFeb\n17\n(a) Place of Birth\nBrookville Pa.\n(Year)\n(Month)\n(Day)\n(b) If of foreign birth, when and where did you arrive in the United States?\nAmerican\n6. If foreign born, give date and court of your naturali ation\n7. (a) Single, married or widower\nSingle\n(a) Number of Dependents none\n(b) Full name of wife before marriage; or husband Single\n(c) Birthplace of wife or husband Single\nNationality of wife or husband\nSingle\n(d) Birthplace and nationality of father of wife or husband\n(e) Birthplace and nationality of mother of wife or husband\nSingle\n(f) Full name of father\nCyrus Butler Wilson\n(g)\nBirthplace and nationality of father Brookville Jefferson Co. Penna\nAmerican\n(h) If father foreign born, whether naturalized, when and where Ame orican Born\n(i) Full maiden name of mother\nAnna ForKum\n(j) Birthplace and nationality of mother Sligo Clarion Co, Penna\n(k) If mother foreign born, whether naturalized, when and where American Born\n(1) Full name and nationality of paternal grandfather Wm. ForKum American\n(m) Full maiden name and nationality of paternal grandmother Kathryn Jabe Moody\n(n) Full name and nationality of maternal grandfather\nEnock H. Wilson\n(o)\nFull maiden name and nationality of maternal grandmother\nElizabeth Butler\n8. (a) What previous business or professional experience have you had, stating nature, places and principal\ndates thereof; the names of the firms or corporations with which you were associated\nEngaged in Private Nursing."
}