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Z ORIGINAL Form No. 200 Revised 5-15-18 211 to ni 2012000 AMERICAN RED CROSS vd Ile 10 91632 doirw to ari to Vas SERVICE APPLICATION FORM M M Applicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus at T of the American Red Cross. These questions must be answered fully or the application will not be acted upon. S VIIE nu TEW 01 i Date I. Name in full marie B. Rhodes e Telephone No. M 2. Permanent Address 1945 5th Ave .079 vilenoiten no beand (Number and Street) bm Isiononed Cattsburgh Pa. (City) bas 3. Temporary Address, if any, to what date Tatham House ----------- The - as 138 East 38th (Number and Street) New (City) you U.Y. (State) 4. (a) If any changes of residence since August I, 1914, give these in full with dates nsonsmA 1945 5th are Pghic. 1914-11-918- France 1918111220 (n) .TI (b) What is your present bushness or profession? nurse 10 M ,22010 bost Duration of Service 5 years Name of firm or corporation with which associated Eyes - Ear Hospital Pgb.P. Business Address Sbebnons sgolloo 10 Present Capacity unemployer (Number and Street) (City) don (Staté) oge DOV nsO .01 5. Date of Birth 1886 (Year) sept (Month) 23rd(a) (Day) Place 03 (ton of birth (D) Pittsbugg (b) If of foreign birth, when and where did you arrive in the United States? tadio as 6. If foreign born, give date and court of your naturalization - dose lo subalwond to 7. (a) Single, married or widower single soudt lo (a) Number of Dependents none 5 M (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 american burn Parents es THOV robiaros JOV ob (d) (e) Birthplace and nationality of mother of wife or husband (f) Full name of father mathew Thomas Rholls - deceased) (g) Birthplace and nationality of father american (b) - Lawrence County Pa 10 VOC nI 19309 bluoW PO (h) If father foreign born, whether naturalized, when and where bns Vsg modriw 9V102 uoy bluoW (D) basi ard 11.0 (i) Full maiden name of mother Wella Vance Rhoden - deceased (j) Birthplace and nationality of mother washington Co throsh Pa sonewollA 01 zong anivil not (k) If mother foreign born, whether naturalized, when and where otinu 103 TO sonswollA nairenized 01 869879V0 701 (I) Full name and nationality of paternal grandfather Jnuons (m) Full maiden name and nationality of paternal grandmother Lannence Countyle Pa. doidw: margarite Rhodes (n) name Full and nationality of maternal grandfather Justiness P. Vance (o) Full maiden name and nationality of maternal grandmother washington and Co. Pa W 8. (a) What previous business or professional experience have you had, stating nature, places and principal dates margacPatters. Uance thereof; the names of the firms or corporations with which you were associated operating Room supervision since 1911- 1911-13 Pathlung Cheldrun Hospital in pittsbugg 1913-18 Eye g Eur Hospital

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170
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0
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2661226
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Type
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Document source extras
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Page context
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    "ocrText": "Z\nORIGINAL\nForm No. 200\nRevised 5-15-18\n211 to ni 2012000\nAMERICAN RED CROSS vd Ile 10 91632\ndoirw to\nari to Vas\nSERVICE APPLICATION FORM\nM\nM\nApplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus\nat\nT\nof the American Red Cross.\nThese questions must be answered fully or the application will not be acted upon.\nS\nVIIE nu TEW 01\ni\nDate\nI. Name in full marie B. Rhodes\ne\nTelephone No.\nM\n2. Permanent Address 1945 5th Ave\n.079 vilenoiten no beand (Number and Street)\nbm\nIsiononed\nCattsburgh\nPa.\n(City)\nbas\n3. Temporary Address, if any, to what date Tatham House -----------\nThe\n-\nas\n138 East 38th\n(Number and Street)\nNew (City) you\nU.Y.\n(State)\n4. (a) If any changes of residence since August I, 1914, give these in full with dates\nnsonsmA 1945 5th are Pghic. 1914-11-918- France 1918111220\n(n)\n.TI\n(b) What is your present bushness or profession? nurse 10 M ,22010 bost\nDuration of Service 5 years\nName of firm or corporation with which associated Eyes - Ear Hospital Pgb.P.\nBusiness Address\nSbebnons sgolloo 10\nPresent Capacity unemployer\n(Number and Street)\n(City)\ndon (Staté) oge DOV nsO .01\n5.\nDate of Birth 1886 (Year) sept (Month) 23rd(a) (Day) Place 03 (ton of birth (D) Pittsbugg\n(b) If of foreign birth, when and where did you arrive in the United States?\ntadio\nas\n6. If foreign born, give date and court of your naturalization\n-\ndose lo subalwond to\n7.\n(a) Single, married or widower single soudt lo (a) Number of Dependents none\n5\nM\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 american burn Parents\nes\nTHOV robiaros JOV ob (d)\n(e) Birthplace and nationality of mother of wife or husband\n(f)\nFull name of father mathew Thomas Rholls - deceased)\n(g) Birthplace and nationality of father american (b) - Lawrence County Pa\n10 VOC nI\n19309 bluoW PO\n(h) If father foreign born, whether naturalized, when and where\nbns Vsg modriw 9V102 uoy bluoW (D)\nbasi ard\n11.0\n(i)\nFull maiden name of mother Wella Vance Rhoden - deceased\n(j)\nBirthplace and nationality of mother washington Co throsh Pa sonewollA\n01 zong anivil not\n(k) If mother foreign born, whether naturalized, when and where otinu 103 TO sonswollA\nnairenized 01 869879V0 701\n(I) Full name and nationality of paternal grandfather\nJnuons\n(m) Full maiden name and nationality of paternal grandmother\nLannence Countyle Pa.\ndoidw:\nmargarite Rhodes\n(n) name\nFull and nationality of maternal grandfather Justiness P. Vance\n(o) Full maiden name and nationality of maternal grandmother\nwashington and Co. Pa\nW\n8.\n(a) What previous business or professional experience have you had, stating nature, places and principal dates\nmargacPatters. Uance\nthereof; the names of the firms or corporations with which you were associated\noperating Room supervision since 1911- 1911-13 Pathlung Cheldrun Hospital\nin pittsbugg\n1913-18 Eye g Eur Hospital"
}