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I
ORIGINAL
works No. 200
Revised 5-15 18
AMERICAN RED CROSS
SERVICE APPLICATION FORM
G,
e
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 march 28-1919
to
redment
1. Name in full Bruner, Hazel Gertrude
Telephone No S.R. . 975
2. Permanent Address 431 Second Street, Santa (City) Rosa (State) California
(Number and Street)
3. Temporary Address, if any, to what date
same
(Number and Street)
(City)
(State)
4. (a) If any changes of residence since August 1, 1914, give these in full with dates From 2401 Sac.St.
S an Francisco Dec. 7-1917 to Scotland h B H # 2
(b) What is or ?
your present business profession Graduate nurse
Name of firm or corporation with which associated
-
Duration of Service
Business Address 431 Second Street Santa Roza
Present Capacity Private nursing
(Number and Street)
(City)
(State)
Calif
5. Date of Birth 1891 (Year) aug. (Day) 7
(a) Place of birth Santa Roza
Eslif
(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
Single
(a) Number of Dependents none
(b) Full name of wife before marriage; or husband
to
(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 Clement mannille Bruner
(g) Birthplace and nationality of father
Iowa
-
american
(h) If father foreign born, whether naturalized, when and where
-
(i) Full maiden name of mother Edith msWilliams
has
(j) Birthplace and nationality of mother Missouri - american
-
(k) If mother foreign born, whether naturalized, when and where
(l) Full name and nationality of paternal grandfather Daniel Bruner
American
(m)
Full maiden name and nationality of paternal grandmother american Angeline metcalf
d
(n) Full name and nationality of maternal
grandfather John Calvron msWilliams
American
(o) Full maiden name and nationality of maternal grandmother Marion Louise Shappard
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 Student
before nursing Private hursing since 1913- in San Francisco
15 months infiliation service in the have Base Hospital
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"ocrText": "I\nORIGINAL\nworks No. 200\nRevised 5-15 18\nAMERICAN RED CROSS\nSERVICE APPLICATION FORM\nG,\ne\nApplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaus\nof the American Red Cross.\nThese questions must be answered fully or the application will not be acted upon.\nDate march 28-1919\nto\nredment\n1. Name in full Bruner, Hazel Gertrude\nTelephone No S.R. . 975\n2. Permanent Address 431 Second Street, Santa (City) Rosa (State) California\n(Number and Street)\n3. Temporary Address, if any, to what date\nsame\n(Number and Street)\n(City)\n(State)\n4. (a) If any changes of residence since August 1, 1914, give these in full with dates From 2401 Sac.St.\nS an Francisco Dec. 7-1917 to Scotland h B H # 2\n(b) What is or ?\nyour present business profession Graduate nurse\nName of firm or corporation with which associated\n-\nDuration of Service\nBusiness Address 431 Second Street Santa Roza\nPresent Capacity Private nursing\n(Number and Street)\n(City)\n(State)\nCalif\n5. Date of Birth 1891 (Year) aug. (Day) 7\n(a) Place of birth Santa Roza\nEslif\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\nSingle\n(a) Number of Dependents none\n(b) Full name of wife before marriage; or husband\nto\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) Birthplace and nationality of mother of wife or husband\n(f)\nFull name of father Clement mannille Bruner\n(g) Birthplace and nationality of father\nIowa\n-\namerican\n(h) If father foreign born, whether naturalized, when and where\n-\n(i) Full maiden name of mother Edith msWilliams\nhas\n(j) Birthplace and nationality of mother Missouri - american\n-\n(k) If mother foreign born, whether naturalized, when and where\n(l) Full name and nationality of paternal grandfather Daniel Bruner\nAmerican\n(m)\nFull maiden name and nationality of paternal grandmother american Angeline metcalf\nd\n(n) Full name and nationality of maternal\ngrandfather John Calvron msWilliams\nAmerican\n(o) Full maiden name and nationality of maternal grandmother Marion Louise Shappard\nAmerican\n8. (a) What previous business or professional experience have you had, stating nature, places and principal\ndates thereof; the names of the firms or corporations with which you were associated Student\nbefore nursing Private hursing since 1913- in San Francisco\n15 months infiliation service in the have Base Hospital"
}