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5
es,
DUPLICATE
Form No. 200
M
Revised 5-15-18
baginU sil lo 10W silt ni aníauoo
AMERICAN RED CROSS
vd asvinalor Ila to comso .21
+
bollorits doidw ni solvisa to
SERVICE APPLICATION FORM
poga ani lo vas 10)
Applicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus
+
of the American Red Cross.
These questions must be answered fully or the application will not be acted upon.
Date
basto monesinagio 10 1092 lo nodmom S
June 24,1918
omen 271 11
innol
I. Name in full
Myrtle Nellie Hines
Telephone No
2. Permanent Address
Frederick - Maryland
(Number and Street)
(City)
N
(State)
3. Temporary Address, if any, to what date
Jane McAlister Hospital, Waukegan, Illinois
(Number and Street)
(City)
-
(State)
4. (a) If any changes of residence since August I, 1914, give these in full with dates August 1914-Feb-5-1917
-
220 Fulton Avenue, Baltimore, Maryland February 5,1917-Jane McAlister Hospital
Waukega Illinois
(b) What is your present business or profession? Nursing
e
Name of firm or corporation with which associated
Duration of Service
Present Capacity
Business Address
(Number and Street)
(City)
(State)
5. Date of Birth 1887.
April
8
(a) Place of birth
Frederick Co. Maryland n°O.
(Year)
(Montb)
(Day)
nov
(U)
(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
(a) Number of Dependents
(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
(e)
Birthplace and nationality of mother of wife or husband
(f)
Full name of father Charles William Hines
(g) Birthplace and nationality of father Frederick County-Maryland
American
(h) If father foreign born, whether naturalized, when and where
(i)
Full maiden name of mother Florence Stone-Frederick City-Maryland
(j) Birthplace and nationality of mother
American
(k) If mother foreign born, whether naturalized, when and where
(I) Full name and nationality of paternal grandfather James Hines
American
Jnu
(m) Full maiden name and nationality of paternal grandmother Elizabeth Holter American
(n) Full name and nationality of maternal grandfather
John Stone American
2
(o) Full maiden name and nationality of maternal grandmother Lydia Gettzendaumer
American
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
8
Page data
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- Source index
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- Type
- photo
- Media ID
- 99f895d41068de41
- Size
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Document data
- ID
- 2661643
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Page context
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"ocrText": "I\n5\nes,\nDUPLICATE\nForm No. 200\nM\nRevised 5-15-18\nbaginU sil lo 10W silt ni aníauoo\nAMERICAN RED CROSS\nvd asvinalor Ila to comso .21\n+\nbollorits doidw ni solvisa to\nSERVICE APPLICATION FORM\npoga ani lo vas 10)\nApplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus\n+\nof the American Red Cross.\nThese questions must be answered fully or the application will not be acted upon.\nDate\nbasto monesinagio 10 1092 lo nodmom S\nJune 24,1918\nomen 271 11\ninnol\nI. Name in full\nMyrtle Nellie Hines\nTelephone No\n2. Permanent Address\nFrederick - Maryland\n(Number and Street)\n(City)\nN\n(State)\n3. Temporary Address, if any, to what date\nJane McAlister Hospital, Waukegan, Illinois\n(Number and Street)\n(City)\n-\n(State)\n4. (a) If any changes of residence since August I, 1914, give these in full with dates August 1914-Feb-5-1917\n-\n220 Fulton Avenue, Baltimore, Maryland February 5,1917-Jane McAlister Hospital\nWaukega Illinois\n(b) What is your present business or profession? Nursing\ne\nName of firm or corporation with which associated\nDuration of Service\nPresent Capacity\nBusiness Address\n(Number and Street)\n(City)\n(State)\n5. Date of Birth 1887.\nApril\n8\n(a) Place of birth\nFrederick Co. Maryland n°O.\n(Year)\n(Montb)\n(Day)\nnov\n(U)\n(b) If of foreign birth, when and where did you arrive in the United States?\n6. If foreign born, give date and court of your naturalization\n7. (a) Single, married or widower\n(a) Number of Dependents\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\n(e)\nBirthplace and nationality of mother of wife or husband\n(f)\nFull name of father Charles William Hines\n(g) Birthplace and nationality of father Frederick County-Maryland\nAmerican\n(h) If father foreign born, whether naturalized, when and where\n(i)\nFull maiden name of mother Florence Stone-Frederick City-Maryland\n(j) Birthplace and nationality of mother\nAmerican\n(k) If mother foreign born, whether naturalized, when and where\n(I) Full name and nationality of paternal grandfather James Hines\nAmerican\nJnu\n(m) Full maiden name and nationality of paternal grandmother Elizabeth Holter American\n(n) Full name and nationality of maternal grandfather\nJohn Stone American\n2\n(o) Full maiden name and nationality of maternal grandmother Lydia Gettzendaumer\nAmerican\n8. (a) What previous business or professional experience have you had, stating nature, places and principal dates\nthereof; the names of the firms or corporations with which you were associated\n8"
}