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QUADRUPLICATE
Form No. 200
Revised 5-15-18
AMERICAN RED CROSS
SERVICE APPLICATION FORM
22231
Bethere
3
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.
?
5
Date
Aug. 3, 1918.
I. Name in full
Minnie Mas rtha Bethune
Telephone No.
2510
2. Permanent Address
Av.;
P
e
(Stäte)
3. Temporary Address, if any, to what date
(Number and Street)
(City)
(State)
M
4. (a) If any changes of residence since August I, 1914, give these in full with dates
at
(b) What is your present business or profession?
Gradus te nurse
Name of firm or corporation with which associated
+
West Penn tospital
Duration of Service. Sinee-graduation--1909
Present Capacity Graduate nurse
Business Address
(Number and Street)
(City)
(State)
5. Date of Birth
(Year)
1880 (Montb) June 26 (Day) (a) Place of birth Forest home, Penna.
(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 NONE
(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
James Murry RETHUNE (deceased)
(g) Birthplace and nationality of father
Mirrysville; Pa:
American
(h) If father foreign born, whether naturalized, when and where
(i) Full maiden name of mother
(i) Birthplace and nationality of mother.
Herri - Cityy Pai American-
(k) If mother foreign born, whether naturalized, when and where
(I) Full name and nationality of paternal grandfather
Do not know. Fronch-
2
(m) Full maiden name and nationality of paternal grandmother
Do not know
(n) Full name and nationality of maternal grandfather
u
Do not know
Sco. ch
W
(o) Full maiden name and nationality of maternal grandmother.
Do not know.
Scatch.
6
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 Privato nureing.
Page data
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- Source index
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- Type
- photo
- Media ID
- 716b0db3e0aa16a4
- Size
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Document data
- ID
- 2661111
- Core
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- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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"ocrText": "-\ne\nit's\n+\n+\n5\n&\nQUADRUPLICATE\nForm No. 200\nRevised 5-15-18\nAMERICAN RED CROSS\nSERVICE APPLICATION FORM\n22231\nBethere\n3\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.\n?\n5\nDate\nAug. 3, 1918.\nI. Name in full\nMinnie Mas rtha Bethune\nTelephone No.\n2510\n2. Permanent Address\nAv.;\nP\ne\n(Stäte)\n3. Temporary Address, if any, to what date\n(Number and Street)\n(City)\n(State)\nM\n4. (a) If any changes of residence since August I, 1914, give these in full with dates\nat\n(b) What is your present business or profession?\nGradus te nurse\nName of firm or corporation with which associated\n+\nWest Penn tospital\nDuration of Service. Sinee-graduation--1909\nPresent Capacity Graduate nurse\nBusiness Address\n(Number and Street)\n(City)\n(State)\n5. Date of Birth\n(Year)\n1880 (Montb) June 26 (Day) (a) Place of birth Forest home, Penna.\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 NONE\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) Birthplace and nationality of mother of wife or husband\n(f) Full name of father\nJames Murry RETHUNE (deceased)\n(g) Birthplace and nationality of father\nMirrysville; Pa:\nAmerican\n(h) If father foreign born, whether naturalized, when and where\n(i) Full maiden name of mother\n(i) Birthplace and nationality of mother.\nHerri - Cityy Pai American-\n(k) If mother foreign born, whether naturalized, when and where\n(I) Full name and nationality of paternal grandfather\nDo not know. Fronch-\n2\n(m) Full maiden name and nationality of paternal grandmother\nDo not know\n(n) Full name and nationality of maternal grandfather\nu\nDo not know\nSco. ch\nW\n(o) Full maiden name and nationality of maternal grandmother.\nDo not know.\nScatch.\n6\n8. (a) What 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 Privato nureing."
}