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QUADRUPLICATE Form No. 200 Revised 5-15-18 AMERICAN RED CROSS 22814 SERVICE APPLICATION FORM M Applicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus Ts. of the American Red Cross. These questions must be answered fully or the application will not be acted upon. Date August 2, 1918. I. Name in full Bertha Cornelia Maugle, Telephone No. 49-M. 2. Permanent Address Everett, Penna. (Number and Street) (City) (State) 3. Temporary Address, if any, to what date Roaring Spring until August 8, 1918, (Number and Street) (City) (State) 4. (a) If any changes of residence since August I, 1914, give these in full with dates. (b) What is your present business or profession? Nursing Name of firm or corporation with which associated The Nason Hospital Duration of Service 11 months Present Capacity Operating room Business Address Roaring Spring nurse (Number and Street) (City) (State) Everett 5. Date of Birth 1882 27 (a) Place of birth (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 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 (g) Birthplace and nationality of father Thomas Maugle Bedford Co., Scotch Irish (h) If father foreign born, whether naturalized, when and where (i) Full maiden name of mother Hettie Maria Faulknor, (j) Birthplace and nationality of mother Blair Co. Penna. Dutch. (k) If mother foreign born, whether naturalized, when and where (1) Full name and nationality of paternal grandfather. Maugle Scotch Irish (m) Full maiden name and nationality of paternal grandmother Do not know (n) Full name and nationality of maternal grandfather George Faulknor, Penna.Dutch (o) Full maiden name and nationality of maternal grandmother Do not know. 2 N 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 Clerk in general store, Everett, 1900 to 1907, A.H. Whetstone.

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Context sent to Scholar

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Page context
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    "ocrText": "QUADRUPLICATE\nForm No. 200\nRevised 5-15-18\nAMERICAN RED CROSS\n22814\nSERVICE APPLICATION FORM\nM\nApplicants\nfor Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus\nTs.\nof the American Red Cross.\nThese questions must be answered fully or the application will not be acted upon.\nDate August 2, 1918.\nI. Name in full\nBertha Cornelia Maugle,\nTelephone No.\n49-M.\n2. Permanent Address\nEverett,\nPenna.\n(Number and Street)\n(City)\n(State)\n3. Temporary Address, if any, to what date Roaring Spring until August 8, 1918,\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.\n(b) What is your present business or profession?\nNursing\nName of firm or corporation with which associated\nThe Nason Hospital\nDuration of Service\n11 months\nPresent Capacity Operating room\nBusiness Address\nRoaring Spring\nnurse\n(Number and Street)\n(City)\n(State)\nEverett\n5. Date of Birth\n1882\n27\n(a) Place of birth\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 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\n(g) Birthplace and nationality of father\nThomas Maugle\nBedford Co., Scotch Irish\n(h) If father foreign born, whether naturalized, when and where\n(i) Full maiden name of mother\nHettie Maria Faulknor,\n(j) Birthplace and nationality of mother\nBlair Co.\nPenna. Dutch.\n(k) If mother foreign born, whether naturalized, when and where\n(1) Full name and nationality of paternal grandfather.\nMaugle\nScotch Irish\n(m) Full maiden name and nationality of paternal grandmother\nDo not know\n(n) Full name and nationality of maternal grandfather George Faulknor, Penna.Dutch\n(o) Full maiden name and nationality of maternal grandmother\nDo not know.\n2\nN\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\nClerk in general store, Everett, 1900 to 1907, A.H. Whetstone."
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