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Mrs.
(p)
Names of all relatives nearer than second cousins in the war service of the United States Government.
Not any
5. If foreign born, give date and court of your naturalization
ar
6. Single, married, widow, or widower.
widow
(a) Number of dependents Not any
(b) Full name and address of nearest relative or friend Cecilia Wilson (mothor)
1228 East Moyamensing Ave., Phila., Pa.
(c) Full name of wife before marriage; or husband
Thomas F. Clark
(d) Birthplace of wife or husband Phila., Pa. (e) Nationality of wife or husband
American
(f) Birthplace and nationality of father of wife or husband Phila., Pa.
(g) Birthplace and nationality of mother of wife or husband
7. Kind of service preferred. (Specify.)
Nurse
8. Would you enter foreign service? Yes (a) If so, in what country or countries? France
(b) Describe fully any experience you have ever had in service of the American Red Cross.
Not any so far.
9. Would you serve without pay and defray all of your necessary expenses? I have no income,could not
afford it.
(a) With only expenses defrayed for you?
No.
(b) If not, what minimum salary would you require in addition to the defraying of your expenses?
IO. What University or College attended?
Year graduated
II. Can you speak French fluently
No.
(a) If not, to what degree, if any ? not any
(b) Can you translate French easily?
=m.
(c) If not, to what degree, if any ?
I2. What other foreign languages do you speak None
(a) State extent of your knowledge of each
I3. As references, give names and addresses of three American citizens not related to you.
Dr. Henry Morris, 313 S. 16th St., Phila., Pa.
Dr. Robort Rhoin, 400 S. 15th St., Phila., Pa.
Mrs. Katherine D. Lichty, 658 N., Frazior Philar, Pa.
14. Give names and addresses of all patriotic, beneficial, social or other form of clubs, societies or other organiza-
tions based on race, nationality, etc., to which you belong or have at any time belonged, since August I, 1914.
Do not belong to any
15. If enrolled in service, name earliest date you could take up work Any time
I hereby certify that the answers to the above questions are correct to the best of my knowledge and belief.
Martha S. Clark
Signature.
Division Personnel Committee examining application
Date of report
Report of Committee. (Be specific.)
Date of receipt at National Headquarters
Checked by
Comments:
6
Page data
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Document data
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- Core
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- Type
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"ocrText": "Mrs.\n(p)\nNames of all relatives nearer than second cousins in the war service of the United States Government.\nNot any\n5. If foreign born, give date and court of your naturalization\nar\n6. Single, married, widow, or widower.\nwidow\n(a) Number of dependents Not any\n(b) Full name and address of nearest relative or friend Cecilia Wilson (mothor)\n1228 East Moyamensing Ave., Phila., Pa.\n(c) Full name of wife before marriage; or husband\nThomas F. Clark\n(d) Birthplace of wife or husband Phila., Pa. (e) Nationality of wife or husband\nAmerican\n(f) Birthplace and nationality of father of wife or husband Phila., Pa.\n(g) Birthplace and nationality of mother of wife or husband\n7. Kind of service preferred. (Specify.)\nNurse\n8. Would you enter foreign service? Yes (a) If so, in what country or countries? France\n(b) Describe fully any experience you have ever had in service of the American Red Cross.\nNot any so far.\n9. Would you serve without pay and defray all of your necessary expenses? I have no income,could not\nafford it.\n(a) With only expenses defrayed for you?\nNo.\n(b) If not, what minimum salary would you require in addition to the defraying of your expenses?\nIO. What University or College attended?\nYear graduated\nII. Can you speak French fluently\nNo.\n(a) If not, to what degree, if any ? not any\n(b) Can you translate French easily?\n=m.\n(c) If not, to what degree, if any ?\nI2. What other foreign languages do you speak None\n(a) State extent of your knowledge of each\nI3. As references, give names and addresses of three American citizens not related to you.\nDr. Henry Morris, 313 S. 16th St., Phila., Pa.\nDr. Robort Rhoin, 400 S. 15th St., Phila., Pa.\nMrs. Katherine D. Lichty, 658 N., Frazior Philar, Pa.\n14. Give names and addresses of all patriotic, beneficial, social or other form of clubs, societies or other organiza-\ntions based on race, nationality, etc., to which you belong or have at any time belonged, since August I, 1914.\nDo not belong to any\n15. If enrolled in service, name earliest date you could take up work Any time\nI hereby certify that the answers to the above questions are correct to the best of my knowledge and belief.\nMartha S. Clark\nSignature.\nDivision Personnel Committee examining application\nDate of report\nReport of Committee. (Be specific.)\nDate of receipt at National Headquarters\nChecked by\nComments:\n6"
}