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OCR Page 1 of 14E
FORM 493
THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
APPLICATION FOR ENROLMENT AS HOME DEFENSE NURSE
(To be filled out entirely in applicant's handwriting and each question answered fully)
1. Name of applicant in full
Buell allen Louise
If married, maiden name
2. Address in full Street
1016 Madison
City Syracuse , State n.4.
ux
3.
Date of birth. May 11- 1889
Place of birth
Earlicle n.y.
4. Are you married, single, or a widow?
single
Are you a citizen of the U.S. A.? yes
5. Are you physically strong and healthy ?
yes
6. Name educational institutions attended before entering training school
Grammar school Earhille High school Earlville N.H. College T.P. Columbia
7. What languages other than English do you speak?
none
8. Occupation before entering training school
none
J 9. From what hospital training school did you receive your diploma? Faxton School of Nursing
10. hospital General? yes
Character of
Special ? -
Private?
Utica, n. ef
July 1911.
11. If you are a registered nurse, in what State are you registered ? neu york
12. State how you have been employed since graduation, including present employment Private duty yrs
Institutional lyr. Public health nursing 13 years.
13. Are you willing to take the oath of allegiance?
yes
*14. Are you an annual member of the American Red Cross?
yes,
15. Name some representative of your local Red Cross Chapter to whom we may refer
miss Clara Hurd
16. Specify for which of the following services you wish to be considered:
Disaster
Visiting nurse
(a) With remuneration
Emergency
Hourly service
"
Institutional
Instructor in Elementary Hygiene
(b) Without
and Home Care of the Sick
Could you accept temporary service away from home? not with present position
Clinic nurse
17. 18. Name and permanent address of nearest relative or friend 7 e. Buell, Earlielle n.y.
Date July 17-1931
Signature Ellen L. Buell
* This refers to membership obtained through the payment of $1.00 to your Local Chapter annually at the time of the Red Cross
Roll Ca
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