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Van Duzor, Charlotte E.
2897
15 training
APPLICATION BLANK
F6. Specify experience in the following:
(This blank is to be filled out entirely in applicant's own handwriting. Enrolled Red Cross nurses need not answer questions
Obstetrics Training and in Dritry Where nursing
Between what dates
4 to 10 inclusive. Give badge number 2897
31 mos. 1912
1. Full name of applicant Charlotte Elizabeth Van Duzor
Pediatrics
Training
(permanent)
2. Address in full
37 East 71 sheel, new you City
Contagious nursing
(temporary) 419 Wht 115 Ahuta " "
"
Public Health Nursing
3. Nationality
us
Religious faith Eolestant
Name and address
,1881
birth Sitchfield, Pa.
Where
Between what dates
of person in charge
4. Year of birth
Place of
5. Are you married, single or a widow?
General visiting nursing Hore.
Oct.-DIC.1710
Mis M.a. Bewley
6. Occupation before entering training school
Imigi See
Infant welfare
7. From what hospital training school were you graduated?
n 4 C. City and State
restytens
Tuberculosis Freshy Hosp blimo
Way 1911-
Date
School nursing Neimoni laty- Observation under
the anna kerr.
8. Daily average number of patients in hospital during training 230 Length of course 3 you
9. Character of hospital : General?
Special?
Private? Roomer
Sept. 1911- Jely 1915
Industrial nursing
10. Name and address of present superintendent of training school, or one under whom you received training
anna mapiell
Sanitary inspection
11. Of what nursing organizations are you a member? N.Y. asm Hospital Social Service Novers
Other social work.
Preohyterial Hoop alumnae bentral blut for Nurser n.y.: Monday blut n.yi
Nati Red 62020
17. If at present employed, state where and for how long with Miss M. E. Madley at
12. Give name and address of secretary of at least one of these organizations.
Man Edith Granger (Socy Protem Presenterials alum) 119 Femimore Att Brooklyn
Billerve Hospital, Social Service Office.
Give
name
and
address
of
13. Are you a registered nurse yr In what State? my
Date of registration ept, 1911
present employer. Min. ME Nadley, Gx, beiy
14. Educational institutions attended before entering training school
imily
Belleve Hospital new you City
18. Other employment since graduation from hospital training school:
Number
Date of
Name and address
AtPaul. Min
Character of work
Between what dates
of person in charge
byean.
of years
graduation
Common schools
High school
Organization global Majo
Oct, 1911 - May 12"
Myself in charge Financed by
Other educational institutions At Josaphs Academy
4
May 1896
Visiting huring assw. Waterlow
"
16
A.P.a Minin
Districh Nursing
July- at 1912
Myselfun change Subtotilated for
experience
(Substitute)
Whis H-Van bleft, Lakeville born
15. Specify training in the following
19. If you have not had sufficient training or experience to qualify you as a Red Cross visiting nurse, are you
Obstetrics Please Hope Tal Where for Nomen ny
June Between aug- what dates
willing to take a four-months' course? -
On what date could you begin it?
20. Have you ever worked or lived in country districts? yes
Pediatrics
21. Are you accustomed to driving? yes
horseback riding?
yes
Contagious nursing.
22. What languages other than English do you speak? German - lone Halian
bicycle riding? yes
Public Health Nursing:
Where
In
Name and address
23. Have you any preference as to locality of work? near newyour City
Between what dates
of person in charge
-
your bity Training
Oct- Dec. 1910
General visiting nursing Laveriece Coun
M.a. Bewley PN,
July - Sapt-1912
24. On what date would you be free to begin work if appointed? Mch. / HN
As to nationality or denomination?
no -
Presby time stop
25. Have you any physical defects or tendency to constitutional or pulmonary trouble?
no.
Infant welfare
Patter Myself in change
Are you physically strong and heaithy?
Tuberculosis
Myself charge
26.
Name
and
address
of
nearest
relative
Mr blara Hall lister) 815 Eighth ave
yrs.
School nursing
Watertown n.y.
Oct. 1911-May 1912
France Fisdale Sept JSchools,
Industrial nursing
Remarks Please note Hat through my error 15 and #16 are interchange
Grooklyn n.y.
Sanitary inspection
Bellene Honpital n.y. few Mr.M.E. Hadley
Date Feby 10 417 -
Other social work
makevell Yan sleft
Signature Charlott E. Van Duegor
1strading
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"ocrText": "Van Duzor, Charlotte E.\n2897\n15 training\nAPPLICATION BLANK\nF6. Specify experience in the following:\n(This blank is to be filled out entirely in applicant's own handwriting. Enrolled Red Cross nurses need not answer questions\nObstetrics Training and in Dritry Where nursing\nBetween what dates\n4 to 10 inclusive. Give badge number 2897\n31 mos. 1912\n1. Full name of applicant Charlotte Elizabeth Van Duzor\nPediatrics\nTraining\n(permanent)\n2. Address in full\n37 East 71 sheel, new you City\nContagious nursing\n(temporary) 419 Wht 115 Ahuta \" \"\n\"\nPublic Health Nursing\n3. Nationality\nus\nReligious faith Eolestant\nName and address\n,1881\nbirth Sitchfield, Pa.\nWhere\nBetween what dates\nof person in charge\n4. Year of birth\nPlace of\n5. Are you married, single or a widow?\nGeneral visiting nursing Hore.\nOct.-DIC.1710\nMis M.a. Bewley\n6. Occupation before entering training school\nImigi See\nInfant welfare\n7. From what hospital training school were you graduated?\nn 4 C. City and State\nrestytens\nTuberculosis Freshy Hosp blimo\nWay 1911-\nDate\nSchool nursing Neimoni laty- Observation under\nthe anna kerr.\n8. Daily average number of patients in hospital during training 230 Length of course 3 you\n9. Character of hospital : General?\nSpecial?\nPrivate? Roomer\nSept. 1911- Jely 1915\nIndustrial nursing\n10. Name and address of present superintendent of training school, or one under whom you received training\nanna mapiell\nSanitary inspection\n11. Of what nursing organizations are you a member? N.Y. asm Hospital Social Service Novers\nOther social work.\nPreohyterial Hoop alumnae bentral blut for Nurser n.y.: Monday blut n.yi\nNati Red 62020\n17. If at present employed, state where and for how long with Miss M. E. Madley at\n12. Give name and address of secretary of at least one of these organizations.\nMan Edith Granger (Socy Protem Presenterials alum) 119 Femimore Att Brooklyn\nBillerve Hospital, Social Service Office.\nGive\nname\nand\naddress\nof\n13. Are you a registered nurse yr In what State? my\nDate of registration ept, 1911\npresent employer. Min. ME Nadley, Gx, beiy\n14. Educational institutions attended before entering training school\nimily\nBelleve Hospital new you City\n18. Other employment since graduation from hospital training school:\nNumber\nDate of\nName and address\nAtPaul. Min\nCharacter of work\nBetween what dates\nof person in charge\nbyean.\nof years\ngraduation\nCommon schools\nHigh school\nOrganization global Majo\nOct, 1911 - May 12\"\nMyself in charge Financed by\nOther educational institutions At Josaphs Academy\n4\nMay 1896\nVisiting huring assw. Waterlow\n\"\n16\nA.P.a Minin\nDistrich Nursing\nJuly- at 1912\nMyselfun change Subtotilated for\nexperience\n(Substitute)\nWhis H-Van bleft, Lakeville born\n15. Specify training in the following\n19. If you have not had sufficient training or experience to qualify you as a Red Cross visiting nurse, are you\nObstetrics Please Hope Tal Where for Nomen ny\nJune Between aug- what dates\nwilling to take a four-months' course? -\nOn what date could you begin it?\n20. Have you ever worked or lived in country districts? yes\nPediatrics\n21. Are you accustomed to driving? yes\nhorseback riding?\nyes\nContagious nursing.\n22. What languages other than English do you speak? German - lone Halian\nbicycle riding? yes\nPublic Health Nursing:\nWhere\nIn\nName and address\n23. Have you any preference as to locality of work? near newyour City\nBetween what dates\nof person in charge\n-\nyour bity Training\nOct- Dec. 1910\nGeneral visiting nursing Laveriece Coun\nM.a. Bewley PN,\nJuly - Sapt-1912\n24. On what date would you be free to begin work if appointed? Mch. / HN\nAs to nationality or denomination?\nno -\nPresby time stop\n25. Have you any physical defects or tendency to constitutional or pulmonary trouble?\nno.\nInfant welfare\nPatter Myself in change\nAre you physically strong and heaithy?\nTuberculosis\nMyself charge\n26.\nName\nand\naddress\nof\nnearest\nrelative\nMr blara Hall lister) 815 Eighth ave\nyrs.\nSchool nursing\nWatertown n.y.\nOct. 1911-May 1912\nFrance Fisdale Sept JSchools,\nIndustrial nursing\nRemarks Please note Hat through my error 15 and #16 are interchange\nGrooklyn n.y.\nSanitary inspection\nBellene Honpital n.y. few Mr.M.E. Hadley\nDate Feby 10 417 -\nOther social work\nmakevell Yan sleft\nSignature Charlott E. Van Duegor\n1strading"
}