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Form No. 469-(1)
THE AMERICAN RED CROSS
ENROLLMENT FORM
Pacific Division
To
BUREAU OF PERSONNEL,
From Nursing Department
American Red Cross Headquarters,
Date. April 14, 1919
4 Place de la Concorde, Paris, France.
Approved Els bir H. breeephun
1. Name
Bruner, Hazel G. (Nurse)
2. Address
431 Second St., Santa Rosa, Calif.
SAN
3. Temporary address, if any
4. Going to what countries
Siberia
5. Nature of work
Enrolled Red Cross Nurse
EMBARKATIO.
FRANCISCO
6. Suggested rank
7. Length of stay (six months or over ?)
1 year or more
8. Proposed approximate date of departure
Booked
Sailed
9. Cable number in compliance with which above is being sent Siberian - 55
10. Is appointee volunteer
No
day of departure for
11. If not volunteer, what salary per month is promised $ 70.00
12. To begin. San Francisco
13. What allowance, if any, for transportation in United States? $
TO San Francisco and return
14. What allowance, if any, for transportation (steamship) ? $
To destination and return
4.00 day from date requested to report
15. What allowance, if any, for living expenses prior to departure? $ in San Franciscota day of sailing
16. What allowance, if any, for uniform equipment ? $ Yes, requisitioned at New York office
17. What allowance, if any, for living expenses abroad? $
Yes, regulation allowance
18. Is there to be an assignment of part or all of salary ? yes $40 per months
19. Has the proper form been sent to the Life Extension Institute?
accepted
INSTRUCTIONS TO APPLICANT
Where allowances mentioned above are to be paid in America, payment will be made at the New York office,
222 Fourth Avenue, near 18th Street.
In case you wish to assign part of your salary to any one in the United States, please indicate such assignment
in duplicate on the attached forms and return to the Bureau of Personnel, American Red Cross, Washington, D.C.
This is the only form that can be accepted for these assignments.
Questions pertaining to rank are determined entirely in the Paris office. Any reference to rank in the above
is a suggestion only.
I have noted carefully the above.
(Signed)
Hazel g Bruner.
NOTE.-Signature should not be affixed until applicant has been accepted, when this document will be forwarded to applicant for sig-
nature, by Bureau of Personnel, American Red Cross, Washington, D. C., to whom it should be returned.
Date of Birth - August 7, 1891
Page data
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Document data
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- Core
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Context sent to Scholar
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"ocrText": "Form No. 469-(1)\nTHE AMERICAN RED CROSS\nENROLLMENT FORM\nPacific Division\nTo\nBUREAU OF PERSONNEL,\nFrom Nursing Department\nAmerican Red Cross Headquarters,\nDate. April 14, 1919\n4 Place de la Concorde, Paris, France.\nApproved Els bir H. breeephun\n1. Name\nBruner, Hazel G. (Nurse)\n2. Address\n431 Second St., Santa Rosa, Calif.\nSAN\n3. Temporary address, if any\n4. Going to what countries\nSiberia\n5. Nature of work\nEnrolled Red Cross Nurse\nEMBARKATIO.\nFRANCISCO\n6. Suggested rank\n7. Length of stay (six months or over ?)\n1 year or more\n8. Proposed approximate date of departure\nBooked\nSailed\n9. Cable number in compliance with which above is being sent Siberian - 55\n10. Is appointee volunteer\nNo\nday of departure for\n11. If not volunteer, what salary per month is promised $ 70.00\n12. To begin. San Francisco\n13. What allowance, if any, for transportation in United States? $\nTO San Francisco and return\n14. What allowance, if any, for transportation (steamship) ? $\nTo destination and return\n4.00 day from date requested to report\n15. What allowance, if any, for living expenses prior to departure? $ in San Franciscota day of sailing\n16. What allowance, if any, for uniform equipment ? $ Yes, requisitioned at New York office\n17. What allowance, if any, for living expenses abroad? $\nYes, regulation allowance\n18. Is there to be an assignment of part or all of salary ? yes $40 per months\n19. Has the proper form been sent to the Life Extension Institute?\naccepted\nINSTRUCTIONS TO APPLICANT\nWhere allowances mentioned above are to be paid in America, payment will be made at the New York office,\n222 Fourth Avenue, near 18th Street.\nIn case you wish to assign part of your salary to any one in the United States, please indicate such assignment\nin duplicate on the attached forms and return to the Bureau of Personnel, American Red Cross, Washington, D.C.\nThis is the only form that can be accepted for these assignments.\nQuestions pertaining to rank are determined entirely in the Paris office. Any reference to rank in the above\nis a suggestion only.\nI have noted carefully the above.\n(Signed)\nHazel g Bruner.\nNOTE.-Signature should not be affixed until applicant has been accepted, when this document will be forwarded to applicant for sig-\nnature, by Bureau of Personnel, American Red Cross, Washington, D. C., to whom it should be returned.\nDate of Birth - August 7, 1891"
}