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QUINTUPLICATE
Form No. 200
Revised 5-15-18
AMERICAN RED CROSS
SERVICE APPLICATION FORM
Applicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaue
of the American Red Cross.
These questions must be answered fully or the application will not be acted upon.
Date
I. Name in Ygtl. 1st., 1918
Telephone No.
2. Permanent Address Hattie Olga Wilson
289
(Number
and
28
Mill
Street)
Plymouth
Wisc.
(State)
3. Temporary Address, if any, to what date
28 a Mill St.
(Number and Street)
Plymouth
Wisc(State)
4. (a) If any changes of residence since August I, 1914, give these in full with dates.
Sheb.Wis. 623 S 14th St.,
Moose What is Canpadsent bDeife 23 plafes on Plymouth Wisc. June 1st., 1918
Name of firm or corporation with which associated Registered nurse
Duration of Service
Present Capacity
Business Address
21 years
(Number and Street)
(City)
virnault don (State)
5. Date of Birth
(a) Place of birth
1873
(Mon
Oct
25
Rolla Missouri
(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
(a) Number of Dependents:
(b) Full name of wife before marriage,
husband
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
(g) Birthplace and nationali John Peter Wilson
New York City
American
(h) If father foreign born, whether naturalized, when and where
box
(i) Full maiden name of mother
(j) Birthplace and nationality of mother
Henrietta Kesweter
Neustadt Brunswick
Germany
(k) If mother foreign born, whether naturalized, when and where
Matercial grandfather
was zed of was 21 years old
John Wilson
Swedish
(m) Full maiden name and nationality of paternal grandmother
Anna Rebecca Selman Swedish
(n) Full name and nationality of maternal grandfather
Andrew Kesweter
German
(o) Full maiden name and nationality of maternal grandmother
Henreitta Spengler German
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
none
Page data
- Page
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- Source index
- 0
- Type
- photo
- Media ID
- c00959f468a7e24e
- Size
- unknown
Document data
- ID
- 2662491
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "QUINTUPLICATE\nForm No. 200\nRevised 5-15-18\nAMERICAN RED CROSS\nSERVICE APPLICATION FORM\nApplicants for Nursing and Medical Service must accompany this form with special forms supplied by the Nursing Service and the Medical Service Bureaue\nof the American Red Cross.\nThese questions must be answered fully or the application will not be acted upon.\nDate\nI. Name in Ygtl. 1st., 1918\nTelephone No.\n2. Permanent Address Hattie Olga Wilson\n289\n(Number\nand\n28\nMill\nStreet)\nPlymouth\nWisc.\n(State)\n3. Temporary Address, if any, to what date\n28 a Mill St.\n(Number and Street)\nPlymouth\nWisc(State)\n4. (a) If any changes of residence since August I, 1914, give these in full with dates.\nSheb.Wis. 623 S 14th St.,\nMoose What is Canpadsent bDeife 23 plafes on Plymouth Wisc. June 1st., 1918\nName of firm or corporation with which associated Registered nurse\nDuration of Service\nPresent Capacity\nBusiness Address\n21 years\n(Number and Street)\n(City)\nvirnault don (State)\n5. Date of Birth\n(a) Place of birth\n1873\n(Mon\nOct\n25\nRolla Missouri\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\n(a) Number of Dependents:\n(b) Full name of wife before marriage,\nhusband\nc) 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) Full name of father\n(g) Birthplace and nationali John Peter Wilson\nNew York City\nAmerican\n(h) If father foreign born, whether naturalized, when and where\nbox\n(i) Full maiden name of mother\n(j) Birthplace and nationality of mother\nHenrietta Kesweter\nNeustadt Brunswick\nGermany\n(k) If mother foreign born, whether naturalized, when and where\nMatercial grandfather\nwas zed of was 21 years old\nJohn Wilson\nSwedish\n(m) Full maiden name and nationality of paternal grandmother\nAnna Rebecca Selman Swedish\n(n) Full name and nationality of maternal grandfather\nAndrew Kesweter\nGerman\n(o) Full maiden name and nationality of maternal grandmother\nHenreitta Spengler German\n8.\n(a) What previous business or professional experience have you had, stating nature, places and principal dates\nthereof; the names of the firms or corporations with which you were associated\nnone"
}