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ORIGINAL
Form No. 200
Revised 5-15-18 soivion 16W ada ni anianos
to asmea ords 23632 21
bolloins dbidw ni soivina to done
AMERICAN RED CROSS
ati to TO
M
allows
SERVICE APPLICATION FORM
blue
Applicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus
at
of the American Red Cross.
T
10W ni 09510 beonw upon. 6 uov 91A (n) at
These questions must be answered fully or the application will not be acted
,
Date
april 21 1919
I. Name in full
marie gessen
Telephone No. Rhinelander 9460
2. Permanent Address
1.079 9061 no beand (Number and Street) 1002 bris , (City)il to bas n.4. (d)
721 w Church st.
Elmina,
3. Temporary Address, if any, to what date. 37 E 71 sut n.4.c.
(Number and Street)
(City)
(State)
4. (a) If any changes of residence since August I, 1914, give these in full with dates
nsonemA
onla
10 bolloino noa TO TUOZ siA (n) 51
2
(b) What is your present business or profession? resignstrument nurse operating be Room
a
Name of firm or corporation with which associated dour Trestylenan Hospital
Duration of Service
18 months
Present Capacity
s ame
Business Address
169Y
Tresly tericin n.4.c 81
(Number and Street)'s sedw 01 11 (D)
(City)
nouß
dons
(State)
oga
007
noO.
5. Date
of Birth 1894 July 22 (a) Place of birth Emira.
(Year)
(Day)
n.4.
+6)
(b) If of foreign birth, when and where did you arrive in the United States? rigisto) os
6. If foreign born, give date and court of your naturalization
to TIOV lo 91612
7. (a) or
Single, married Jon anssiai; single sonda lo Number of Dependents pistonane
(b) Full name of wife before marriage; or husband
proposit
c) Birthplace of wife or husband
S
animal
Nationality of wife or husband
matter
a
and
(d) Birthplace and nationality of father of wife or husband
991V192 to (n) se
uov anina 1009 of redW (d)
(e) Birthplace and nationality of mother of wife or husband
(f) Full name of father. arb to spivisa Call 19V9 Insurand Jessen (b)
(g) Birthplace and nationality of father
Denmale
Dane
stadw 10 yns nl (D)
ispivisa agisto) 19105 bluoW Es
(h) If father foreign born, whether naturalized, when and yes such 1888 Eemina. - n.4.
bax vd miupar. bluory donda RE. 01 aldenu al (d)
(i) Full maiden name of mother
anna
Hurni
122010
(j) Birthplace and nationality of mother
Suitzerl and
swiss
sonswollA
07 nong anivil not sonswollA
(k) If mother foreign born, whether naturalized, when and where. yes Jot 1890 is son cemina. n.4.
bns 03 not sonswollA
(I) Full name and nationality of paternal grandfather 291672 not Ken own sonswollA
Innomo it zol. assupabs absm. ball. 11 (1)
(m) Full maiden name and nationality of paternal grandmother
that ni. known luow
mbidw muminil. (d)
aman (n) ni, 11 25
(n) Full name and nationality of maternal grandfather
3
not
known 1192.
1
4
(o) Full maiden name and nationality of maternal grandmother not known
avode and 01 alowage arla
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
none
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"ocrText": "ORIGINAL\nForm No. 200\nRevised 5-15-18 soivion 16W ada ni anianos\nto asmea ords 23632 21\nbolloins dbidw ni soivina to done\nAMERICAN RED CROSS\nati to TO\nM\nallows\nSERVICE APPLICATION FORM\nblue\nApplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus\nat\nof the American Red Cross.\nT\n10W ni 09510 beonw upon. 6 uov 91A (n) at\nThese questions must be answered fully or the application will not be acted\n,\nDate\napril 21 1919\nI. Name in full\nmarie gessen\nTelephone No. Rhinelander 9460\n2. Permanent Address\n1.079 9061 no beand (Number and Street) 1002 bris , (City)il to bas n.4. (d)\n721 w Church st.\nElmina,\n3. Temporary Address, if any, to what date. 37 E 71 sut n.4.c.\n(Number and Street)\n(City)\n(State)\n4. (a) If any changes of residence since August I, 1914, give these in full with dates\nnsonemA\nonla\n10 bolloino noa TO TUOZ siA (n) 51\n2\n(b) What is your present business or profession? resignstrument nurse operating be Room\na\nName of firm or corporation with which associated dour Trestylenan Hospital\nDuration of Service\n18 months\nPresent Capacity\ns ame\nBusiness Address\n169Y\nTresly tericin n.4.c 81\n(Number and Street)'s sedw 01 11 (D)\n(City)\nnouß\ndons\n(State)\noga\n007\nnoO.\n5. Date\nof Birth 1894 July 22 (a) Place of birth Emira.\n(Year)\n(Day)\nn.4.\n+6)\n(b) If of foreign birth, when and where did you arrive in the United States? rigisto) os\n6. If foreign born, give date and court of your naturalization\nto TIOV lo 91612\n7. (a) or\nSingle, married Jon anssiai; single sonda lo Number of Dependents pistonane\n(b) Full name of wife before marriage; or husband\nproposit\nc) Birthplace of wife or husband\nS\nanimal\nNationality of wife or husband\nmatter\na\nand\n(d) Birthplace and nationality of father of wife or husband\n991V192 to (n) se\nuov anina 1009 of redW (d)\n(e) Birthplace and nationality of mother of wife or husband\n(f) Full name of father. arb to spivisa Call 19V9 Insurand Jessen (b)\n(g) Birthplace and nationality of father\nDenmale\nDane\nstadw 10 yns nl (D)\nispivisa agisto) 19105 bluoW Es\n(h) If father foreign born, whether naturalized, when and yes such 1888 Eemina. - n.4.\nbax vd miupar. bluory donda RE. 01 aldenu al (d)\n(i) Full maiden name of mother\nanna\nHurni\n122010\n(j) Birthplace and nationality of mother\nSuitzerl and\nswiss\nsonswollA\n07 nong anivil not sonswollA\n(k) If mother foreign born, whether naturalized, when and where. yes Jot 1890 is son cemina. n.4.\nbns 03 not sonswollA\n(I) Full name and nationality of paternal grandfather 291672 not Ken own sonswollA\nInnomo it zol. assupabs absm. ball. 11 (1)\n(m) Full maiden name and nationality of paternal grandmother\nthat ni. known luow\nmbidw muminil. (d)\naman (n) ni, 11 25\n(n) Full name and nationality of maternal grandfather\n3\nnot\nknown 1192.\n1\n4\n(o) Full maiden name and nationality of maternal grandmother not known\navode and 01 alowage arla\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\nnone"
}