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J
AMERICAN RED CROSS
NEW ENGLAND DIVISION
755 BOYLSTON STREET, BOSTON, MASS.
SUREAU OF NURSING
APPLICATION FOR SPECIAL SERVICE
(To be filled in by for the person, organization or institution employing the nurse,
whom special service enrollment is desired.)
M
L
1. Name of Nurse in fulliss Lucia Is Jaquith
(Chevrons sent Aug. 19)
ass
a
2. Address: Street
City Worcester
State Mass.
S
ci
3. Name of person, institution or organization employing nurse
a
Memorial Hospital
4. Address: Street
L
City Worcester,
State Mass.
-
5. Position held by murse_Superintendent of Hospital
6. Description of the duties of the nurse
7. Length of time nurse has been employed in present capacity
8. Is this application filed with the approval of the nurse for whom the special
service recognitien is desired?
9, Do you understand in the event that the nurse is granted a chevron you
should inform this office of any change in her status and return the chevron?
10. How many nurses have been released from the staff for War Work to date?
11. Remarks:
Seal of
Signature
Organization
Title
Address
Date
2
3
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"ocrText": "J\nAMERICAN RED CROSS\nNEW ENGLAND DIVISION\n755 BOYLSTON STREET, BOSTON, MASS.\nSUREAU OF NURSING\nAPPLICATION FOR SPECIAL SERVICE\n(To be filled in by for the person, organization or institution employing the nurse,\nwhom special service enrollment is desired.)\nM\nL\n1. Name of Nurse in fulliss Lucia Is Jaquith\n(Chevrons sent Aug. 19)\nass\na\n2. Address: Street\nCity Worcester\nState Mass.\nS\nci\n3. Name of person, institution or organization employing nurse\na\nMemorial Hospital\n4. Address: Street\nL\nCity Worcester,\nState Mass.\n-\n5. Position held by murse_Superintendent of Hospital\n6. Description of the duties of the nurse\n7. Length of time nurse has been employed in present capacity\n8. Is this application filed with the approval of the nurse for whom the special\nservice recognitien is desired?\n9, Do you understand in the event that the nurse is granted a chevron you\nshould inform this office of any change in her status and return the chevron?\n10. How many nurses have been released from the staff for War Work to date?\n11. Remarks:\nSeal of\nSignature\nOrganization\nTitle\nAddress\nDate\n2\n3"
}