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Form No. 469-(2)
:
THE AMERICAN RED CROSS
ENROLLMENT FORM
20467
M
W
New England Division
oyage number
To
THE DIVISION OF TRANSPORTATION,
From Nursing Depar tment
BUREAU OF PERSONNEL.
Date April 23, 1919
Approval of Director,
Approved Elserrol A- baughum
Bureau of Personnel
1. Name Stafford, Ada He (Nurse)
2. Address
87 Larch Street, Providence,
3. Temporary address, if any
SAN FRANCISCO
4. Going to what countries
Siberia
5. Nature of work
Enrolled Red Cross Nurse
6. Suggested
EMEARKATION
7. Length of stay (six months or over?
8. Proposed approximate date of departure
Booked
Sailed 6/11/19
9. Cable number in compliance with which above is being sent Siber ian Cable
#55
10. Is appointee volunteer?
No
day of departur
11. If not volunteer, what salary per month is promised ? $ 70.00
12. To begin for 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
15. What allowance, if any, for living expenses prior to departure? report in San Francisco to day
of sailing.
16. What allowance, if any, for uniform equipment ? $
Yes., requisitioned in New York office.
17. What allowance, if any, for living expenses abroad ? $ Yes, regulati allowance.
18. Is there to be an assignment of part or all of salary ?
19. Has the proper form been sent to the Life Extension Institute?
Division of Transportation,
PLEASE LEAVE THE FOLLOWING LINES BLANK.
Correspondence checked:
Note
Mailed
Forms
Clerk of the
Court at
Application for passport filed
Date
Issued
Reservation
Cancelled
Cabled
Cancelled
Date of birth - August 19, 1876.
2
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Document data
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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": "Start:\na\nff\na\nForm No. 469-(2)\n:\nTHE AMERICAN RED CROSS\nENROLLMENT FORM\n20467\nM\nW\nNew England Division\noyage number\nTo\nTHE DIVISION OF TRANSPORTATION,\nFrom Nursing Depar tment\nBUREAU OF PERSONNEL.\nDate April 23, 1919\nApproval of Director,\nApproved Elserrol A- baughum\nBureau of Personnel\n1. Name Stafford, Ada He (Nurse)\n2. Address\n87 Larch Street, Providence,\n3. Temporary address, if any\nSAN FRANCISCO\n4. Going to what countries\nSiberia\n5. Nature of work\nEnrolled Red Cross Nurse\n6. Suggested\nEMEARKATION\n7. Length of stay (six months or over?\n8. Proposed approximate date of departure\nBooked\nSailed 6/11/19\n9. Cable number in compliance with which above is being sent Siber ian Cable\n#55\n10. Is appointee volunteer?\nNo\nday of departur\n11. If not volunteer, what salary per month is promised ? $ 70.00\n12. To begin for San Francisco\n13. What allowance, if any, for transportation in United States $ to San Francisco and return\n14. What allowance, if any, for transportation (steamship) ? $\nTo destination and return\n4.00 day from date requested to\n15. What allowance, if any, for living expenses prior to departure? report in San Francisco to day\nof sailing.\n16. What allowance, if any, for uniform equipment ? $\nYes., requisitioned in New York office.\n17. What allowance, if any, for living expenses abroad ? $ Yes, regulati allowance.\n18. Is there to be an assignment of part or all of salary ?\n19. Has the proper form been sent to the Life Extension Institute?\nDivision of Transportation,\nPLEASE LEAVE THE FOLLOWING LINES BLANK.\nCorrespondence checked:\nNote\nMailed\nForms\nClerk of the\nCourt at\nApplication for passport filed\nDate\nIssued\nReservation\nCancelled\nCabled\nCancelled\nDate of birth - August 19, 1876.\n2"
}