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QUINTUPLICATE
Form No. 200
Revised 5-15-18
sto
91632
art
AMERICAN RED CROSS
séciale
L
batuau
bullegtio didnt at some
SERVICE APPLICATION FORM
-
Applicants for Nursing and Medical Service must accompany this of form with special Red forms Cross. supplied by the Nursing Service and the Medical Service Bureaus
the American
ct
These questions must be answered fully or the application will not be acted upon.
take
birbed
bists
90002
O
DE
Date
July 20, 1918
L
T
Anne Forbes Regd.
Telephone No.
119
1. Name in full
N. P. Hospital
Missoula
Montana
'
2. Permanent Address
(City)
(State)
C
a
(Number and Street)
3. Temporary Address, if any, to what date
(Number and Street)
(City)
N. P. shospital, Missoula
4.
(a) If changes of residence since August I, 1914, give these in full with dates
Montana any Glen Lake Sanitorium, Minneapolis, Minn Jan 1, 1916 to April 22, 1916
Nursing
(b) What is your present business or profession?
Northern Pacific Beneficial Association
Name of firm or corporation with which associated
Duration of Service.
Present Capacity
Business Address
(Number and Street)
(City)
(State)
5. Date of Birth 1891
Dec.
7
(a) Place of birth
Scotland
(Year)
(Month)
(Day)
New York
(b) If of foreign birth, when and where did you arrive in the United States?
Not naturalized
6. If foreign born, give date and court of your naturalization
7. (a) Single, married or widower
Single
(a) Number of Dependents None
None
(b) Full name of wife before marriage; or husband
None
c) Birthplace of wife or husband
None
Nationality of wife or husband
None
(d) Birthplace and nationality of father of wife or husband
None
(e)
Birthplace and nationality of mother of wife or husband
(f) Full name of father
John Reid
Larbert, Stirlingshire, Scotland - Seotch
(g) Birthplace and nationality of father
Naturaliged May 1916
H
(h) If father foreign born, whether naturalized, when and where
at La Crosse, Wisconsin
Anne Forbes
(i) Full maiden name of mother
(j) Birthplace and nationality of mother Inverness, Scotland - Scotch
Naturalized Mayo 1916
(k) If mother foreign born, whether naturalized, when and where
at La Crosse, Wisconsin
David Reid
(1) Full name and nationality of paternal grandfather
Jessie White
(m) Full maiden name and nationality of paternal grandmother
Andrew Forbes
(n) Full name and nationality of maternal grandfather
(0) Full maiden name and nationality of maternal grandmother
Margare's Junor
Ier
8. (a) What previous business or professional experience have you d, stating nature, places and principal dates
thereof; the names of the firms or corporations with which you were associated
None
Page data
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- Source index
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- Type
- photo
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- unknown
Document data
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- 2662087
- Core
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- Type
- document
DTO data
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"ocrText": "el\nQUINTUPLICATE\nForm No. 200\nRevised 5-15-18\nsto\n91632\nart\nAMERICAN RED CROSS\nséciale\nL\nbatuau\nbullegtio didnt at some\nSERVICE APPLICATION FORM\n-\nApplicants for Nursing and Medical Service must accompany this of form with special Red forms Cross. supplied by the Nursing Service and the Medical Service Bureaus\nthe American\nct\nThese questions must be answered fully or the application will not be acted upon.\ntake\nbirbed\nbists\n90002\nO\nDE\nDate\nJuly 20, 1918\nL\nT\nAnne Forbes Regd.\nTelephone No.\n119\n1. Name in full\nN. P. Hospital\nMissoula\nMontana\n'\n2. Permanent Address\n(City)\n(State)\nC\na\n(Number and Street)\n3. Temporary Address, if any, to what date\n(Number and Street)\n(City)\nN. P. shospital, Missoula\n4.\n(a) If changes of residence since August I, 1914, give these in full with dates\nMontana any Glen Lake Sanitorium, Minneapolis, Minn Jan 1, 1916 to April 22, 1916\nNursing\n(b) What is your present business or profession?\nNorthern Pacific Beneficial Association\nName of firm or corporation with which associated\nDuration of Service.\nPresent Capacity\nBusiness Address\n(Number and Street)\n(City)\n(State)\n5. Date of Birth 1891\nDec.\n7\n(a) Place of birth\nScotland\n(Year)\n(Month)\n(Day)\nNew York\n(b) If of foreign birth, when and where did you arrive in the United States?\nNot naturalized\n6. If foreign born, give date and court of your naturalization\n7. (a) Single, married or widower\nSingle\n(a) Number of Dependents None\nNone\n(b) Full name of wife before marriage; or husband\nNone\nc) Birthplace of wife or husband\nNone\nNationality of wife or husband\nNone\n(d) Birthplace and nationality of father of wife or husband\nNone\n(e)\nBirthplace and nationality of mother of wife or husband\n(f) Full name of father\nJohn Reid\nLarbert, Stirlingshire, Scotland - Seotch\n(g) Birthplace and nationality of father\nNaturaliged May 1916\nH\n(h) If father foreign born, whether naturalized, when and where\nat La Crosse, Wisconsin\nAnne Forbes\n(i) Full maiden name of mother\n(j) Birthplace and nationality of mother Inverness, Scotland - Scotch\nNaturalized Mayo 1916\n(k) If mother foreign born, whether naturalized, when and where\nat La Crosse, Wisconsin\nDavid Reid\n(1) Full name and nationality of paternal grandfather\nJessie White\n(m) Full maiden name and nationality of paternal grandmother\nAndrew Forbes\n(n) Full name and nationality of maternal grandfather\n(0) Full maiden name and nationality of maternal grandmother\nMargare's Junor\nIer\n8. (a) What previous business or professional experience have you d, stating nature, places and principal dates\nthereof; the names of the firms or corporations with which you were associated\nNone"
}