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Form No. 469-(1)
THE AMERICAN RED CROSS
ENROLLMENT FORM
Pacific Division
To
BUREAU OF PERSONNEL,
From
Nursing Department
in
American Red Cross Headquarters,
Date
March 4, 1919
4 Place de la Concorde, Paris, France.
Approved Elabord H. bacquen
in
1. Name Forster, Emma C. (Nurse)
2. Address
449 Grand View St. Los Angeles, California
C.
3. Temporary address, if any
4. Going to what countries
Siberia
5. Nature of work Enrolled Red Cross Nurse
6. Suggested rank
7. Length of stay (six months or over?)
1 year or more
8. Proposed approximate date of departure
Booked
Sailed
9. Cable number in compliance with which above is being sent Siberian Cable #58
10. Is appointee volunteer?
No
day of departure for
11. If not volunteer, what salary per month is promised ? $ 70.00
12. To begin San Francisco
13. What allowance, if any, for transportation in United States? $ To San Francisco and return
14. What allowance, if any, for transportation (steamship) ? $
To destination and return
4.00 day from date requested to report
15. What allowance, if any, for living expenses prior to departure ? $ in San Francisco to day. of sailing
16. What allowance, if any, for uniform equipment? $ Yes, requisitioned at New York office
17. What allowance, if any, for living expenses abroad ? $ Yes, regulation allowance
18. Is there to be an assignment of part or all of salary ?
19. Has the proper form been sent to the Life Extension Institute?
INSTRUCTIONS TO APPLICANT
Where allowances mentioned above are to be paid in America, payment will be made at the New York
office, 222 Fourth Avenue, near 18th Street.
In case you wish to assign part of your salary to any one ir the United States, please indicate such as-
signment in duplicate on the attached forms and return to the Bureaeu of Personnel, American Red Cross,
Washington, D. C. This is the only form that can be accepted for these assignments.
Questions pertaining to rank are determined entirely in the Paris office. Any reference to rank in the
above is a suggestion only.
I have noted carefully the above.
(Signed) Euma C.Forster
Note.-Signature should not be affixed until applicant has been accepted, when this document will be forwarded to applicant
for signature, by Bureau of Personnel, American Red Cross, Washington, D. C., to whom it should be returned.
2
g
Date of Birth - March 18, 1878
W
of
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Document data
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"ocrText": "Fl\n0\nS\n+\nForm No. 469-(1)\nTHE AMERICAN RED CROSS\nENROLLMENT FORM\nPacific Division\nTo\nBUREAU OF PERSONNEL,\nFrom\nNursing Department\nin\nAmerican Red Cross Headquarters,\nDate\nMarch 4, 1919\n4 Place de la Concorde, Paris, France.\nApproved Elabord H. bacquen\nin\n1. Name Forster, Emma C. (Nurse)\n2. Address\n449 Grand View St. Los Angeles, California\nC.\n3. Temporary address, if any\n4. Going to what countries\nSiberia\n5. Nature of work Enrolled Red Cross Nurse\n6. Suggested rank\n7. Length of stay (six months or over?)\n1 year or more\n8. Proposed approximate date of departure\nBooked\nSailed\n9. Cable number in compliance with which above is being sent Siberian Cable #58\n10. Is appointee volunteer?\nNo\nday of departure for\n11. If not volunteer, what salary per month is promised ? $ 70.00\n12. To begin San Francisco\n13. What allowance, if any, for transportation in United States? $ To San Francisco and return\n14. What allowance, if any, for transportation (steamship) ? $\nTo destination and return\n4.00 day from date requested to report\n15. What allowance, if any, for living expenses prior to departure ? $ in San Francisco to day. of sailing\n16. What allowance, if any, for uniform equipment? $ Yes, requisitioned at New York office\n17. What allowance, if any, for living expenses abroad ? $ Yes, regulation allowance\n18. Is there to be an assignment of part or all of salary ?\n19. Has the proper form been sent to the Life Extension Institute?\nINSTRUCTIONS TO APPLICANT\nWhere allowances mentioned above are to be paid in America, payment will be made at the New York\noffice, 222 Fourth Avenue, near 18th Street.\nIn case you wish to assign part of your salary to any one ir the United States, please indicate such as-\nsignment in duplicate on the attached forms and return to the Bureaeu of Personnel, American Red Cross,\nWashington, D. C. This is the only form that can be accepted for these assignments.\nQuestions pertaining to rank are determined entirely in the Paris office. Any reference to rank in the\nabove is a suggestion only.\nI have noted carefully the above.\n(Signed) Euma C.Forster\nNote.-Signature should not be affixed until applicant has been accepted, when this document will be forwarded to applicant\nfor signature, by Bureau of Personnel, American Red Cross, Washington, D. C., to whom it should be returned.\n2\ng\nDate of Birth - March 18, 1878\nW\nof"
}