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Form 469.
Assistant to Viee Chai
Revised 11-24-22.
THE AMERICAN RED CROSS
not
Enrollment Form
Date. December 18 1923.
I agree to enter the overseas service of the American Red Cross upon
the following terms and conditions:
Nov. 25, 1980.
1. Name Charlotte M. Heilman,
2. Date of birth,
3. Permanent address (home) Care L. S. Evans, Box 678, Ri chmond, Va.
Above
4.
Address from which enrolled
The same.
5.
Temporary address, if any (for sailing instructions)
6. Name, address and relationship of person to be notified in emergeney
L. S. Evans, Box 678, Richmond, Va.
-
Friend.
7.
Service for which enrolled Director Nursing, A.R. C. Chapter, Dominican Republic.
Jan. 23, 1924
Summoned
Sailed 1/23/24
8. Proposed approximate date of departure.
9. Requested by cable number
or letter from D. R. dated Oct 31, 1923.
To be paid by Chapter.
(January 19, 1924).
perxmonth $2500 .a year, flat ratell Beginning Dat e leaves home. York via
for New York
10. Salary
Richmond to New
12. Allowance for transportation in United States Yes Washington. New York to P: Santo C. and Domingo return. and
13. Allowance for steamship or other transportation Yes return: 3 days in Washington and
14. Allowance for living expenses in United States Yes 1. in. New. York,
15. Allowance abroad for transportation
16. Allowance abroad for living expenses
17. Is there an assignment of salary?
INSTRUCTIONS TO WORKER.
Transportation Service in United States (Item 12) will be paid only from place en-
is subject to termination at any time at discretion of the Red Cross. of
rollment (Item 4) to port of embarkation and return.
case wish to assign part of your salary to anyone in United at States Port of
please In executé you a "Salary assignment" in triplicate on prescribed form
Embarkation.
Personnel enrolled abroad will be given return transportation only to place
of foreign enrollment.
American citizens enrolled abroad, who agree to remain in its Insurance overseas in service
The Red Cross will provide for personnel enrolled in the United States and
for accordance a period with the terms and provisions of Insurance Plan, copy of be
for of at least six months, Life, Health and Accident which will
furnished each worker upon request.
In of disability or sickness incurred in line of duty, the worker at the cover
ed expiration by of which period the salary of the worker will cease and provision.s
this case insurance plan will receive four weeks sick leave with pay, the
of the Insurance Plan will become operative.
J
I have carefully noted and accept the above.
a
Charlein Elie
0
(Signed)
+
A/D Iroquoio
N
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"ocrText": "I\nForm 469.\nAssistant to Viee Chai\nRevised 11-24-22.\nTHE AMERICAN RED CROSS\nnot\nEnrollment Form\nDate. December 18 1923.\nI agree to enter the overseas service of the American Red Cross upon\nthe following terms and conditions:\nNov. 25, 1980.\n1. Name Charlotte M. Heilman,\n2. Date of birth,\n3. Permanent address (home) Care L. S. Evans, Box 678, Ri chmond, Va.\nAbove\n4.\nAddress from which enrolled\nThe same.\n5.\nTemporary address, if any (for sailing instructions)\n6. Name, address and relationship of person to be notified in emergeney\nL. S. Evans, Box 678, Richmond, Va.\n-\nFriend.\n7.\nService for which enrolled Director Nursing, A.R. C. Chapter, Dominican Republic.\nJan. 23, 1924\nSummoned\nSailed 1/23/24\n8. Proposed approximate date of departure.\n9. Requested by cable number\nor letter from D. R. dated Oct 31, 1923.\nTo be paid by Chapter.\n(January 19, 1924).\nperxmonth $2500 .a year, flat ratell Beginning Dat e leaves home. York via\nfor New York\n10. Salary\nRichmond to New\n12. Allowance for transportation in United States Yes Washington. New York to P: Santo C. and Domingo return. and\n13. Allowance for steamship or other transportation Yes return: 3 days in Washington and\n14. Allowance for living expenses in United States Yes 1. in. New. York,\n15. Allowance abroad for transportation\n16. Allowance abroad for living expenses\n17. Is there an assignment of salary?\nINSTRUCTIONS TO WORKER.\nTransportation Service in United States (Item 12) will be paid only from place en-\nis subject to termination at any time at discretion of the Red Cross. of\nrollment (Item 4) to port of embarkation and return.\ncase wish to assign part of your salary to anyone in United at States Port of\nplease In executé you a \"Salary assignment\" in triplicate on prescribed form\nEmbarkation.\nPersonnel enrolled abroad will be given return transportation only to place\nof foreign enrollment.\nAmerican citizens enrolled abroad, who agree to remain in its Insurance overseas in service\nThe Red Cross will provide for personnel enrolled in the United States and\nfor accordance a period with the terms and provisions of Insurance Plan, copy of be\nfor of at least six months, Life, Health and Accident which will\nfurnished each worker upon request.\nIn of disability or sickness incurred in line of duty, the worker at the cover\ned expiration by of which period the salary of the worker will cease and provision.s\nthis case insurance plan will receive four weeks sick leave with pay, the\nof the Insurance Plan will become operative.\nJ\nI have carefully noted and accept the above.\na\nCharlein Elie\n0\n(Signed)\n+\nA/D Iroquoio\nN"
}