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M
FORM NO. 1
-
AMERICAN RED CROSS
NURSING SERVICE
APPLICATION FOR ENROLLMENT
(To be filled out entirely in applicant's handwriting)
1. Name of applicant Josephan Angela numbrille Badge
number
2.
Address in full Holyohu City Hospital, Buch th Extention, Holy mas
33 3. Date of birth march 21, 1883 Place of birth Riverside Come.
4.
Are you married, single or a widow? Singh Are
you
a
citizen
of
the
United
States?
yes
5. Have you any physical defects or tendency to constitutional or pulmonary trouble?
No
D
6. Name educational institutions attended before entering training school, stating number of years at each and
from which you were graduated stamford Come High fehme 4 yrs
mh H. prefit Aminary Hartfand Come
7. Occupation before entering training school Librarian
8. From what hospital training school were you graduated? Give location of hospital and date of graduation
mass general Hospital, Blassom K Briton mass, classofitis
9. hospital: General yes
Character of
Special ?
Private ?
10.
Daily average number of patients in hospital during training 320-325 Length of course 3 yrs.
11.
Name and address of superintendent of training school under whom you received training
Sara E Parsons, non funne Hispital Broton man
12. Of what nursing organizations are you a member ? mun feveral Hospital
fearing fel (affication in for membership in state musco Association)
13. Give name and address of secretary of at least one of these organizations
min Edua H. Hamson Secry man few Leaving fel. Aline man Su.
Braton
14. Are you a registered nurse ? yes In what state ? mass Date of registration apa 1914
15. State how, where and for what period of time, in each instance, you have been employed since graduation,
including present employment man funad Hospital Head nurspire.
Holyrha City Hospital Holuth man Dechanser Lyo.
6.
16. In the event of war are you willing to take the oath of allegiance ? yes.
17. Name and permanent address of nearest relative (mr) Laurine milish Flending
4
sister) 42 neweasth Road Brighton, man
3
Date Danie / 19, 1916
Signature Jusplian Ausela mulville
X
This blank is to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee
to be forwarded with " credentials (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. c.
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- Core
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DTO data
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"ocrText": "M\nFORM NO. 1\n-\nAMERICAN RED CROSS\nNURSING SERVICE\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\n1. Name of applicant Josephan Angela numbrille Badge\nnumber\n2.\nAddress in full Holyohu City Hospital, Buch th Extention, Holy mas\n33 3. Date of birth march 21, 1883 Place of birth Riverside Come.\n4.\nAre you married, single or a widow? Singh Are\nyou\na\ncitizen\nof\nthe\nUnited\nStates?\nyes\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nNo\nD\n6. Name educational institutions attended before entering training school, stating number of years at each and\nfrom which you were graduated stamford Come High fehme 4 yrs\nmh H. prefit Aminary Hartfand Come\n7. Occupation before entering training school Librarian\n8. From what hospital training school were you graduated? Give location of hospital and date of graduation\nmass general Hospital, Blassom K Briton mass, classofitis\n9. hospital: General yes\nCharacter of\nSpecial ?\nPrivate ?\n10.\nDaily average number of patients in hospital during training 320-325 Length of course 3 yrs.\n11.\nName and address of superintendent of training school under whom you received training\nSara E Parsons, non funne Hispital Broton man\n12. Of what nursing organizations are you a member ? mun feveral Hospital\nfearing fel (affication in for membership in state musco Association)\n13. Give name and address of secretary of at least one of these organizations\nmin Edua H. Hamson Secry man few Leaving fel. Aline man Su.\nBraton\n14. Are you a registered nurse ? yes In what state ? mass Date of registration apa 1914\n15. State how, where and for what period of time, in each instance, you have been employed since graduation,\nincluding present employment man funad Hospital Head nurspire.\nHolyrha City Hospital Holuth man Dechanser Lyo.\n6.\n16. In the event of war are you willing to take the oath of allegiance ? yes.\n17. Name and permanent address of nearest relative (mr) Laurine milish Flending\n4\nsister) 42 neweasth Road Brighton, man\n3\nDate Danie / 19, 1916\nSignature Jusplian Ausela mulville\nX\nThis blank is to be sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local Committee\nto be forwarded with \" credentials (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D. c."
}