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TRIPLICATE
Revised -15-18
AMERICAN RED CROSS
SERIVCE APPLICATION FORM
oplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus
Red
Cross
These questions must be answered fully or the application will not be acted upon.
DatOctober 12th; 1918.
1. Name in full. Charlotta Forster
Telephone No. 52984
2. Permanent
Address c/o Mr.: Forster - Main-Ste.; B.O.
(Number and
3. Temporary Address, if any, to what date Until called for serxice - 449.-Grand
View St Los Angeles, Calif,
Number and Street)
(City)
(State)
4. (a) If any changes of residence since August 1, 1914, give these in full with dates. 705 Mese
El Paso, Tex. from Sept. 1914 Aug.1915. Since. then 449. Grand LQS Angel View es St.
(b) What is your present business or profession Med -& Surg. drawing
Name of firm or corporation with which associated
None
Present Capacity
--
Duration of Service.
Business Address
-
(Number and Street)
(City)
(State)
5. Date of Birth 1878. March
18tha) Place of birth Haltimore, Maryland
(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
mm
(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
George H. Forster
(g) Birthplace and nationality of father Hanover, Germany., - German
(h) If father foreign born, whether naturalized, when and where Naturalized in Baltimore
know when
(i) Full maiden name of mother
Rose Simon
(j) Birthplace and nationality of mother Baltimore, Md., - American
If mother foreign born, whether naturalized, when and where --
(1) Full name and nationality of paternal grandfather Geo. H. Forster
(m) Full maiden name and nationality of paternal grandmother Do not kcnow - German
(n) Full name and nationality of maternal grandfather Chas, Simon - German
(o) Full maiden name and nationality of maternal grandmother Maiden name not known
Thin -was born-in-Holland
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 Previous to
entering Training School., assistant Ki ndergarten in Calvery School
xx to Medicine "John Hopkins Med. Dept. Engaged for one year as illustrator
by Dr. Cronse, 31 Pass, Private nurblug drawing in
Los Angeles and Santa Barbara.
Baltimore, Md. Since Graduation Special Nursing and District Nursing
for Babies Milk Fund Association of Baltimore, Md, Head Nurse for 2. seasons in
Thomas ilsons San. for children, Balt. Student in class for Art as appliedxx
(b) Have you or your wife (or husband) at any time had business or professional relationships with sub-
jects, residing abroad, of countries now at war with the United States or its allies No
(c) State the character and extent of such business or professional intercourse
9. (a) Have you ever lived in Europe No If so, give names of European countries in which you have re-
sided, and respective dates of residence in each
(b) Has your wife or husband ever lived in Europe?
(c) If so, give names of European countries in which he or she has resided, and respective dates of residence
in each
(d) Have you ever traveled in Europe? Yes. If so, name countries visited, with respective dates of visits.
France fxom. firet to about middle of July, 1914,
Holland from mid.d le of July until Aug. 1, 1914.
(e) Has your wife or husband ever traveled in Europe
If so, name countries which were visited
with respective dates of visits
(f) Since August 1, 1914, have you or your wife (or husband) applied for a United States passport?
No
If so, state whether application was granted, denied or withdrawn
10. (a) Have you ever been physically examined for war service?
No
(b) If so, state when, where, and if possible the name and address of the examining physician
(c) Were you accepted, rejected, or is the result of the examination pending?
11. State fully your participation in the military service of the United States or its allies in the present war.
12. What previous military service have you had? State the name of the organization with which you were en-
rolled, and in what branch of service, and dates of service
None
13. (a) If on June 5, 1917, you were under 31 years of age, state the official name and address of the Local
Board with which you were registered, and the Class and Division in which you have been placed by
such Local Board
(b) If classified in Class 5, Division G, what was found to be your physical disability?
(c) Is this disability obvious to the casual observer?
14. (a) Names of all relatives by blood or marriage nearer than second cousins residing in Europe..Hone
(b) State the last-known place of residence of each of such persons and the business or profession in which
each of them was engaged
(c) Which of said relatives, if any, are now or have been in the military service of Germany, Austria, Bul-
garia or Turkey?
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Document data
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Context sent to Scholar
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"ocrText": "TRIPLICATE\nRevised -15-18\nAMERICAN RED CROSS\nSERIVCE APPLICATION FORM\noplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus\nRed\nCross\nThese questions must be answered fully or the application will not be acted upon.\nDatOctober 12th; 1918.\n1. Name in full. Charlotta Forster\nTelephone No. 52984\n2. Permanent\nAddress c/o Mr.: Forster - Main-Ste.; B.O.\n(Number and\n3. Temporary Address, if any, to what date Until called for serxice - 449.-Grand\nView St Los Angeles, Calif,\nNumber and Street)\n(City)\n(State)\n4. (a) If any changes of residence since August 1, 1914, give these in full with dates. 705 Mese\nEl Paso, Tex. from Sept. 1914 Aug.1915. Since. then 449. Grand LQS Angel View es St.\n(b) What is your present business or profession Med -& Surg. drawing\nName of firm or corporation with which associated\nNone\nPresent Capacity\n--\nDuration of Service.\nBusiness Address\n-\n(Number and Street)\n(City)\n(State)\n5. Date of Birth 1878. March\n18tha) Place of birth Haltimore, Maryland\n(Year)\n(Month)\n(Day)\n(b) If of foreign birth, when and where did you arrive in the United States?\n--\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\nmm\n(c) Birthplace of wife or husband\nNationality of wife or husband\n(d) Birthplace and nationality of father of wife or husband\n-\n(e) Birthplace and nationality of mother of wife or husband\n.....\n(f) Full name of father\nGeorge H. Forster\n(g) Birthplace and nationality of father Hanover, Germany., - German\n(h) If father foreign born, whether naturalized, when and where Naturalized in Baltimore\nknow when\n(i) Full maiden name of mother\nRose Simon\n(j) Birthplace and nationality of mother Baltimore, Md., - American\nIf mother foreign born, whether naturalized, when and where --\n(1) Full name and nationality of paternal grandfather Geo. H. Forster\n(m) Full maiden name and nationality of paternal grandmother Do not kcnow - German\n(n) Full name and nationality of maternal grandfather Chas, Simon - German\n(o) Full maiden name and nationality of maternal grandmother Maiden name not known\nThin -was born-in-Holland\n8. (a) What previous business or professional experience have you had, stating nature, places and principal\ndates thereof; the names of the firms or corporations with which you were associated Previous to\nentering Training School., assistant Ki ndergarten in Calvery School\nxx to Medicine \"John Hopkins Med. Dept. Engaged for one year as illustrator\nby Dr. Cronse, 31 Pass, Private nurblug drawing in\nLos Angeles and Santa Barbara.\nBaltimore, Md. Since Graduation Special Nursing and District Nursing\nfor Babies Milk Fund Association of Baltimore, Md, Head Nurse for 2. seasons in\nThomas ilsons San. for children, Balt. Student in class for Art as appliedxx\n(b) Have you or your wife (or husband) at any time had business or professional relationships with sub-\njects, residing abroad, of countries now at war with the United States or its allies No\n(c) State the character and extent of such business or professional intercourse\n9. (a) Have you ever lived in Europe No If so, give names of European countries in which you have re-\nsided, and respective dates of residence in each\n(b) Has your wife or husband ever lived in Europe?\n(c) If so, give names of European countries in which he or she has resided, and respective dates of residence\nin each\n(d) Have you ever traveled in Europe? Yes. If so, name countries visited, with respective dates of visits.\nFrance fxom. firet to about middle of July, 1914,\nHolland from mid.d le of July until Aug. 1, 1914.\n(e) Has your wife or husband ever traveled in Europe\nIf so, name countries which were visited\nwith respective dates of visits\n(f) Since August 1, 1914, have you or your wife (or husband) applied for a United States passport?\nNo\nIf so, state whether application was granted, denied or withdrawn\n10. (a) Have you ever been physically examined for war service?\nNo\n(b) If so, state when, where, and if possible the name and address of the examining physician\n(c) Were you accepted, rejected, or is the result of the examination pending?\n11. State fully your participation in the military service of the United States or its allies in the present war.\n12. What previous military service have you had? State the name of the organization with which you were en-\nrolled, and in what branch of service, and dates of service\nNone\n13. (a) If on June 5, 1917, you were under 31 years of age, state the official name and address of the Local\nBoard with which you were registered, and the Class and Division in which you have been placed by\nsuch Local Board\n(b) If classified in Class 5, Division G, what was found to be your physical disability?\n(c) Is this disability obvious to the casual observer?\n14. (a) Names of all relatives by blood or marriage nearer than second cousins residing in Europe..Hone\n(b) State the last-known place of residence of each of such persons and the business or profession in which\neach of them was engaged\n(c) Which of said relatives, if any, are now or have been in the military service of Germany, Austria, Bul-\ngaria or Turkey?"
}