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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.
Page data
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- Type
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Document data
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- 2661114
- Core
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- Type
- document
DTO data
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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."
}