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TIL
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o
and
e)
NURSING SERVICE
good
2
APPLICATION FOR ENROLLMENT
(b
(To be filled out entirely in applicant's handwriting and each question answered fully)
to
1. Name
of applicant in full Neta Blanche Markley
2.
Address in full, Street. Sumey
State Illinois
B
24 3.
Date of birth November 24 -18.93
Place of birth Co.
-
4.
Are you married, single or a widow?
single
Are you a citizen of the United States?
5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no
fer
an
Are you physically strong and healthy?
6.
Name educational institutions attended before entering training school, stating number of years at each and from which
yes
5
you
graduated school and High School
e
were
a
7. What languages other than Englishido you speak?
There School Name
8. Occupation before entering training school
none
o.N.
9.
From what hospital training school did you receive your diploma? Blessing Hospital
City
and state Junery Illinois
Date of graduation May16-1916
11. 12. Did training include obstetrics? your during Care training of men? Fifty: yes. In Children? winter yes. Length Contagious of diseases? yes
10. Character of hospital: General? Special? no
Private? no
your
13.
Daily Name average and address number of superintendent of patients in hospitals of training school under whom you received training Miss course
14. If your training as a nurse was received in more than one hospital, give name, spent no
But P.N. Mayes Hacp St. Joseph location and Mo: time in each
15.
Did. association and Eighth hest. of/Illinous State association
Of what nursing organizations are you a member? Blessing Hospital alumnal
16. Which, if any, is affiliated with the American Nurses Association?
Both
17. Give name and address of secretary of at least one of these organizations
Miss. Martha
securtary 18. Are you a registered 2 nurse? Hospital Illinais alumnal association Distober 1916
In/what state? Date of registration
19. State how, where and for what/ period of time, in each instance, you have been employed since graduation, including present
employment, giving name and address of persons in charge
March 2.4th 1916
Prinate Duty Device
(Specify for which of the following services you wish to be considered.)
20.
War service, wherever needed yes
U. S. only
When available anytime
Are you willing to take the oath of allegiance?
21. Instructor, Elementary Hygiene
no
yes Home Dietetics no
Surgical Dressings no
22. Public Health Nursing in Town and Country Nursing Service no
23. Name and permanent address of nearest relative Mrs. Lanna Markey (mothin)
West Paint Illinois
Date We 28-1917
Signature U. Blanch Markley
To the Committee:
This blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, and A. R. C. 150.
Application forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval and endorsement
by Local Committee, with credentials (Forms 3 and 4) together with Forms 10 and 11, should be forwarded to the Chairman,
National Committee on Nursing Service, American Red Cross, Washington, D. C.
In
case the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to the Local
Committee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the Local Com-
mittee, from whence credentials will be procured.
REQ. 17-876-May 20M
Page data
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Document data
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"ocrText": "M\nar\nTIL\nK\no\nand\ne)\nNURSING SERVICE\ngood\n2\nAPPLICATION FOR ENROLLMENT\n(b\n(To be filled out entirely in applicant's handwriting and each question answered fully)\nto\n1. Name\nof applicant in full Neta Blanche Markley\n2.\nAddress in full, Street. Sumey\nState Illinois\nB\n24 3.\nDate of birth November 24 -18.93\nPlace of birth Co.\n-\n4.\nAre you married, single or a widow?\nsingle\nAre you a citizen of the United States?\n5. Have you any physical defects or tendency to constitutional or pulmonary trouble? no\nfer\nan\nAre you physically strong and healthy?\n6.\nName educational institutions attended before entering training school, stating number of years at each and from which\nyes\n5\nyou\ngraduated school and High School\ne\nwere\na\n7. What languages other than Englishido you speak?\nThere School Name\n8. Occupation before entering training school\nnone\no.N.\n9.\nFrom what hospital training school did you receive your diploma? Blessing Hospital\nCity\nand state Junery Illinois\nDate of graduation May16-1916\n11. 12. Did training include obstetrics? your during Care training of men? Fifty: yes. In Children? winter yes. Length Contagious of diseases? yes\n10. Character of hospital: General? Special? no\nPrivate? no\nyour\n13.\nDaily Name average and address number of superintendent of patients in hospitals of training school under whom you received training Miss course\n14. If your training as a nurse was received in more than one hospital, give name, spent no\nBut P.N. Mayes Hacp St. Joseph location and Mo: time in each\n15.\nDid. association and Eighth hest. of/Illinous State association\nOf what nursing organizations are you a member? Blessing Hospital alumnal\n16. Which, if any, is affiliated with the American Nurses Association?\nBoth\n17. Give name and address of secretary of at least one of these organizations\nMiss. Martha\nsecurtary 18. Are you a registered 2 nurse? Hospital Illinais alumnal association Distober 1916\nIn/what state? Date of registration\n19. State how, where and for what/ period of time, in each instance, you have been employed since graduation, including present\nemployment, giving name and address of persons in charge\nMarch 2.4th 1916\nPrinate Duty Device\n(Specify for which of the following services you wish to be considered.)\n20.\nWar service, wherever needed yes\nU. S. only\nWhen available anytime\nAre you willing to take the oath of allegiance?\n21. Instructor, Elementary Hygiene\nno\nyes Home Dietetics no\nSurgical Dressings no\n22. Public Health Nursing in Town and Country Nursing Service no\n23. Name and permanent address of nearest relative Mrs. Lanna Markey (mothin)\nWest Paint Illinois\nDate We 28-1917\nSignature U. Blanch Markley\nTo the Committee:\nThis blank is to be sent to applicant with circular letter D. M. R. 7, together with Forms D. M. R. 2, 11, and A. R. C. 150.\nApplication forms (except of a nurse desiring to enroll for the Town and Country Nursing Service) after approval and endorsement\nby Local Committee, with credentials (Forms 3 and 4) together with Forms 10 and 11, should be forwarded to the Chairman,\nNational Committee on Nursing Service, American Red Cross, Washington, D. C.\nIn\ncase the application forms of a nurse desiring to enroll for the Town and Country Nursing Service are sent to the Local\nCommittee, instead of to Washington, as instructed, such forms should be forwarded at once to Washington by the Local Com-\nmittee, from whence credentials will be procured.\nREQ. 17-876-May 20M"
}