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5
5
a
Form B. P.-604
for
Revised May 20, 1918
TOP SHEET
a
Upper portion for Divisional Record. Also see last portion of application form.
I
Recommended by autanti Division for enrollment under Requisition nurse
9
5
If not American citizen, so state, and give citizenship
ne:
e
Is applicant available leaving home two weeks from date full papers are rec'd in Washington. yes
Name Agnes mean Shuford Street Address sy1west End amenus off.
16/West66
City new York City
Temporary Address to what date city
to guns/44
3
LANGUAGES SPOKEN
LOCATION OF
PLEASE CHECK OR FILL OUT BLANKS WHERE POSSIBLE.
E-EXCELLENT
G-GOOD F-FAIR
Proposed length of stay
One year
e
SERVICE DESIRED
Full Volunteer
1
Volunteer with expenses met by Red Cross
c
Is allowance for living abroad to be left to discretion of foreign Commission?
Sixexit
Allowance for living abroad if not left to discretion of foreign Commission ?
Salary over expense allowance if any To pu month
Allowance for living prior to departure
Requisition for uniform and equipment
Allowance for transportation overseas and return
Allowance for transportation in U. S. and return
PHYSICAL REPORT
AGE33
Loyalty investigation conducted by (Name of agency employed, if any)
Date Reported
Date examined
and Report
4/24/19
No agency report requested
4/26/19
List of Loyalty indorsements:
Have passport application and pictures been forwarded
Date
Headquarters Record (Initial, date, and "O.K." where acceptable)
FILE RECORD
DATE
REFERRED TO
CLASSIFICATION
Full papers
Provisional Enrollment
2
War Dept.
9,
Physical
Actual Enrollment
6
REMARKS
6
Page data
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- Source index
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- Type
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- dbb0055df442ddca
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Document data
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- 2662253
- Core
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- Type
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DTO data
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Context sent to Scholar
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Document source extras
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"ocrText": "5\n5\na\nForm B. P.-604\nfor\nRevised May 20, 1918\nTOP SHEET\na\nUpper portion for Divisional Record. Also see last portion of application form.\nI\nRecommended by autanti Division for enrollment under Requisition nurse\n9\n5\nIf not American citizen, so state, and give citizenship\nne:\ne\nIs applicant available leaving home two weeks from date full papers are rec'd in Washington. yes\nName Agnes mean Shuford Street Address sy1west End amenus off.\n16/West66\nCity new York City\nTemporary Address to what date city\nto guns/44\n3\nLANGUAGES SPOKEN\nLOCATION OF\nPLEASE CHECK OR FILL OUT BLANKS WHERE POSSIBLE.\nE-EXCELLENT\nG-GOOD F-FAIR\nProposed length of stay\nOne year\ne\nSERVICE DESIRED\nFull Volunteer\n1\nVolunteer with expenses met by Red Cross\nc\nIs allowance for living abroad to be left to discretion of foreign Commission?\nSixexit\nAllowance for living abroad if not left to discretion of foreign Commission ?\nSalary over expense allowance if any To pu month\nAllowance for living prior to departure\nRequisition for uniform and equipment\nAllowance for transportation overseas and return\nAllowance for transportation in U. S. and return\nPHYSICAL REPORT\nAGE33\nLoyalty investigation conducted by (Name of agency employed, if any)\nDate Reported\nDate examined\nand Report\n4/24/19\nNo agency report requested\n4/26/19\nList of Loyalty indorsements:\nHave passport application and pictures been forwarded\nDate\nHeadquarters Record (Initial, date, and \"O.K.\" where acceptable)\nFILE RECORD\nDATE\nREFERRED TO\nCLASSIFICATION\nFull papers\nProvisional Enrollment\n2\nWar Dept.\n9,\nPhysical\nActual Enrollment\n6\nREMARKS\n6"
}