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DUPLICATE 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 the American Red Cross. These questions must be answered fully or the application will not be acted upon. Date July 19, 1918. I. Name in full Juliet Snyder Telephone No. Preston 3482 2. Permanent Address 417 N. Preston St., Phila., Pa. (Number and Street) (City) (State) 3. Temporary Address, if any, to what date. July 28, 1918 c/o L. Ashmore, Canadenses, Monroe Co., Pa. (Number and Street) (City) (State) 4. (a) If any changes of residence since August I, 1914, give these in full with dates 723 .40th, Phila.9/1/15 403 Baring Phila. 6/30/16, 737 M. 41st St., Phila. 1/3/18. (b) What is your present business or profession? Hospital Social Service Nurse in Child.Dept Name of firm or corporation with which associated Presbyterian Hospital, Phila., Pa. Duration of Service. 1 yr. 8. months. Present Capacity. Nurse in Child. Business Address 9th St. & Powelton Av., Phila Asst. to Chief. (Number and Street) (City) (State) Eb 5. Date of Birth 1874 Dec (a) Place of birth Phila., Pa. (Year) (Month) (Day) (b) If of foreign birth, when and where did you arrive in the United States? 6. If foreign born, give date and court of your naturalization 7. (a) Single, married or widower Single (a) Number of Dependents (b) Full name of wife before marriage; or husband (c) Birthplace of wife or husband Nationality of wife or husband (d) Birthplace and nationality of father of wife or husband (e) Birthplace and nationality of mother of wife or husband. (f) Full name of father John Henry Snyder (deceased) (g) Birthplace and nationality of father. Phila. , Pa. American (h) If father foreign born, whether naturalized, when and where (i) Full maiden name of mother Annie Elizabeth Thomas (deceased) (j) Birthplace and nationality of mother. Summit Hill, Pa. American. (k) If mother foreign born, whether naturalized, when and where (1) Full name and nationality of paternal grandfather Nicholas Snyder Phila., Pa. (deceased) American (m) Full maiden name and nationality of paternal grandmother Julia Rodman, Phila., Pa. (deceased) American (n) Full name and nationality of maternal grandfather John Humes, Wales, Great Britain Came here. when a small boy -- died before my mother was born. (o) Full maiden name and nationality of maternal grandmother. Eliza Evans, Wales, Great Britain. Came to Penna. of age deceased. 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 Stenographer clerk Curtis Pub.Co.,Phila., 1894--1904. Head Nurse Hahnemann Hosp., Phila., Pa. March Oct. 1909. (Ann May Hospital) Supt. of Nurses Oct. 1909 -- May 1910. Spring Lake, N.J. Supt. of Nurses West Phila. Gen. Homopathic Hosp. Phila. Oct.1910--Dec.1912 Staff Nurse, Public School Nurses, Phila., Pa. 1913 Sept. - Dec. 1916. (b) Have you or your wife (or husband) at any time had business or professional relationships with subjects, residing abroad, of countries now at war with the United States or its allies. ai bx0297 (c) State the character and extent of such business or professional intercourse 9. (a) Have you ever lived in Europe? NO If so, give names of European countries in which you have resided, behile and respective dates of residence in each (b) Has your wife or husband ever lived in Europe? (c) If so, give names of European countries in which he or she has resided, and respective dates of residence in each (d) Have you ever traveled in Europe? NO If so, name countries visited, with respective dates of visits. Juo (e) Has your wife or husband ever traveled in Europe? If so, name countries which were visited, with respective dates of visits. (f) Since August I, 1914, have you or your wife (or husband) applied for a United States passport? NO noissnim If so, state whether application was granted, denied or withdrawn 10. (a) Have you ever been physically. examined for war service? YES (b) If so, state when, where, and if possible the name and address of the examining physician June 26, 1918 Phila.. Pa. Dr. F. Hurst Maier 2035 Chestnut St., Phila., Pa. (c) Were you accepted, rejected, or is the result of the examination pending? Accepted II. State fully your participation in the military service of the United States or its allies in the present war None but desire to do Child Welfare Work in France. 12. What previous military service have you had? State the name of the organization with which you were enrolled, and in what branch of service, and dates of service. 13. (a) If on June 5, 1917, you were under 31 years of age, state the official name and address of the Local Board with which you were registered, and the Class and Division in which you have been placed by such Local Board (b) If classified in Class 5, Division G, what was found to be your physical disability? (c) Is this disability obvious to the casual observer? 14. (a) Names of all relatives by blood or marriage nearer than second cousins residing in Europe (b) State the last-known place of residence of each of such persons and the business or profession in which each of them was engaged (c) Which of said relatives, if any, are now or have been in the military service of Germany, Austria, Bulgaria or Turkey?

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    "ocrText": "DUPLICATE\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\nthe American Red Cross.\nThese questions must be answered fully or the application will not be acted upon.\nDate\nJuly 19, 1918.\nI. Name in full Juliet Snyder\nTelephone No. Preston 3482\n2. Permanent Address\n417 N. Preston St.,\nPhila.,\nPa.\n(Number and Street)\n(City)\n(State)\n3. Temporary Address, if any, to what date.\nJuly 28, 1918\nc/o L. Ashmore, Canadenses, Monroe Co., Pa.\n(Number and Street)\n(City)\n(State)\n4. (a) If any changes of residence since August I, 1914, give these in full with dates 723 .40th, Phila.9/1/15\n403 Baring Phila. 6/30/16, 737 M. 41st St., Phila. 1/3/18.\n(b)\nWhat is your present business or profession? Hospital Social Service Nurse in Child.Dept\nName of firm or corporation with which associated Presbyterian Hospital, Phila., Pa.\nDuration of Service. 1 yr. 8. months.\nPresent Capacity. Nurse in Child.\nBusiness Address 9th St. & Powelton Av., Phila Asst. to Chief.\n(Number and Street)\n(City)\n(State)\nEb 5. Date of Birth\n1874\nDec\n(a) Place of birth\nPhila., Pa.\n(Year)\n(Month)\n(Day)\n(b) If of foreign birth, when and where did you arrive in the United States?\n6. If foreign born, give date and court of your naturalization\n7. (a) Single, married or widower\nSingle\n(a) Number of Dependents\n(b) Full name of wife before marriage; or husband\n(c) Birthplace of wife or husband\nNationality of wife or husband\n(d) Birthplace and nationality of father of wife or husband\n(e)\nBirthplace and nationality of mother of wife or husband.\n(f) Full name of father\nJohn Henry Snyder (deceased)\n(g) Birthplace and nationality of father.\nPhila. , Pa.\nAmerican\n(h) If father foreign born, whether naturalized, when and where\n(i) Full maiden name of mother\nAnnie Elizabeth Thomas (deceased)\n(j) Birthplace and nationality of mother. Summit Hill, Pa.\nAmerican.\n(k) If mother foreign born, whether naturalized, when and where\n(1) Full name and nationality of paternal grandfather Nicholas Snyder Phila., Pa.\n(deceased)\nAmerican\n(m) Full maiden name and nationality of paternal grandmother Julia Rodman, Phila., Pa.\n(deceased)\nAmerican\n(n) Full name and nationality of maternal grandfather John Humes, Wales, Great Britain\nCame here. when a small boy -- died before my mother was born.\n(o) Full maiden name and nationality of maternal grandmother. Eliza Evans, Wales, Great Britain.\nCame to Penna. of age deceased.\n8.\n(a)\nWhat previous business or professional experience have you had, stating nature, places and principal dates\nthereof; the names of the firms or corporations with which you were associated Stenographer clerk\nCurtis Pub.Co.,Phila., 1894--1904.\nHead Nurse Hahnemann Hosp., Phila., Pa. March Oct. 1909.\n(Ann May Hospital) Supt. of Nurses Oct. 1909 -- May 1910.\nSpring Lake, N.J.\nSupt. of Nurses West Phila. Gen. Homopathic Hosp. Phila. Oct.1910--Dec.1912\nStaff Nurse, Public School Nurses, Phila., Pa. 1913 Sept. - Dec. 1916.\n(b) Have you or your wife (or husband) at any time had business or professional relationships with subjects,\nresiding abroad, of countries now at war with the United States or its allies.\nai\nbx0297\n(c) State the character and extent of such business or professional intercourse\n9. (a) Have you ever lived in Europe? NO If so, give names of European countries in which you have resided,\nbehile and respective dates of residence in each\n(b) Has your wife or husband ever lived in Europe?\n(c) If so, give names of European countries in which he or she has resided, and respective dates of residence\nin each\n(d) Have you ever traveled in Europe?\nNO If so, name countries visited, with respective dates of visits.\nJuo\n(e) Has your wife or husband ever traveled in Europe?\nIf so, name countries which were visited,\nwith respective dates of visits.\n(f) Since August I, 1914, have you or your wife (or husband) applied for a United States passport?\nNO\nnoissnim If so, state whether application was granted, denied or withdrawn\n10. (a) Have you ever been physically. examined for war service?\nYES\n(b) If so, state when, where, and if possible the name and address of the examining physician\nJune 26, 1918 Phila.. Pa. Dr. F. Hurst Maier\n2035 Chestnut St., Phila., Pa.\n(c) Were you accepted, rejected, or is the result of the examination pending? Accepted\nII. State fully your participation in the military service of the United States or its allies in the present war\nNone but desire to do Child Welfare Work in France.\n12. What previous military service have you had? State the name of the organization with which you were enrolled,\nand in what branch of service, and dates of service.\n13. (a) If on June 5, 1917, you were under 31 years of age, state the official name and address of the Local Board\nwith which you were registered, and the Class and Division in which you have been placed by such Local\nBoard\n(b) If classified in Class 5, Division G, what was found to be your physical disability?\n(c) Is this disability obvious to the casual observer?\n14. (a) Names of all relatives by blood or marriage nearer than second cousins residing in Europe\n(b) State the last-known place of residence of each of such persons and the business or profession in which each\nof them was engaged\n(c) Which of said relatives, if any, are now or have been in the military service of Germany, Austria, Bulgaria\nor Turkey?"
}