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15.
State the names of all relatives by blood or marriage nearer than second cousins in the war service of the United
States or any of its allies, specifying which ally in every case and the branch of service in which enrolled.
Edward Bergert U.S. Inft.
16. (a) Are you a member of a religious sect or organization whose creed forbids you to participate in war in any
form?
If so, state its name
no
(b) Give names and addresses of all patriotic, beneficial and social organizations based on race, nationality, etc.,
to which you have at any time belonged
no
17. (a) Are your father, husband, brother or son enrolled in, or about to enroll in foreign service of the American
Red Cross, Y. M. C. A., K. of C., or other similar organizations?
(b) If so, state the name of any such organization
none
18. What university or college attended?
Year graduated
19. Can you speak French fluently?
(a) If not, to what degree, if any?
(b) Can you translate French easily
na
(c) If not, to what degree, if any?
20. What other foreign languages do you speak?
State extent of your knowledge of each
German
can understand & speak German fairly well
21. As references, give names and addresses of three American citizens not related to you
Dr Charles Squire Sheboygan Wisc.
B.A. Dow Plymouth Wisc.
Chas D. Eastman
Plymouth, Wiso.
22. (a) Kind of service preferred
Surgical work or anarsthesia
(b) What do you consider your qualifications particularly fitting you for this service?
Special training and many years of experience
(c) Describe fully any experience you have ever had in the service of the Red Cross
none
23. Would you enter foreign service?
(a) In any country or countries where required?
24. (a) Would you serve without pay and defray all of your necessary personal expenses?
yes
yes
no
(b) If unable to serve as full self-sustaining volunteer, check following items you would require met by Red
Cross:
Allowance for living abroad
Allowance for living prior to departure
Allowance or requisition for uniform and equipment
no allowance until leaving house
Allowance for transportation overseas to destination and return
Allowance for transportation in United States and return
(c) If Red Cross made adequate allowance for your expenses in the service, as per 24-b, what specific amount
would you require in addition?
$60.00
25. If enrolled in service (a) name earliest date you could take up work
(b) Minimum term for which
you would serve
July 15
duration of the war.
I hereby certify that the answers to the above questions are correct to the best of my knowledge and belief.
Signed
HATTIE OLGA WILSON
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Document data
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"ocrText": "15.\nState the names of all relatives by blood or marriage nearer than second cousins in the war service of the United\nStates or any of its allies, specifying which ally in every case and the branch of service in which enrolled.\nEdward Bergert U.S. Inft.\n16. (a) Are you a member of a religious sect or organization whose creed forbids you to participate in war in any\nform?\nIf so, state its name\nno\n(b) Give names and addresses of all patriotic, beneficial and social organizations based on race, nationality, etc.,\nto which you have at any time belonged\nno\n17. (a) Are your father, husband, brother or son enrolled in, or about to enroll in foreign service of the American\nRed Cross, Y. M. C. A., K. of C., or other similar organizations?\n(b) If so, state the name of any such organization\nnone\n18. What university or college attended?\nYear graduated\n19. Can you speak French fluently?\n(a) If not, to what degree, if any?\n(b) Can you translate French easily\nna\n(c) If not, to what degree, if any?\n20. What other foreign languages do you speak?\nState extent of your knowledge of each\nGerman\ncan understand & speak German fairly well\n21. As references, give names and addresses of three American citizens not related to you\nDr Charles Squire Sheboygan Wisc.\nB.A. Dow Plymouth Wisc.\nChas D. Eastman\nPlymouth, Wiso.\n22. (a) Kind of service preferred\nSurgical work or anarsthesia\n(b) What do you consider your qualifications particularly fitting you for this service?\nSpecial training and many years of experience\n(c) Describe fully any experience you have ever had in the service of the Red Cross\nnone\n23. Would you enter foreign service?\n(a) In any country or countries where required?\n24. (a) Would you serve without pay and defray all of your necessary personal expenses?\nyes\nyes\nno\n(b) If unable to serve as full self-sustaining volunteer, check following items you would require met by Red\nCross:\nAllowance for living abroad\nAllowance for living prior to departure\nAllowance or requisition for uniform and equipment\nno allowance until leaving house\nAllowance for transportation overseas to destination and return\nAllowance for transportation in United States and return\n(c) If Red Cross made adequate allowance for your expenses in the service, as per 24-b, what specific amount\nwould you require in addition?\n$60.00\n25. If enrolled in service (a) name earliest date you could take up work\n(b) Minimum term for which\nyou would serve\nJuly 15\nduration of the war.\nI hereby certify that the answers to the above questions are correct to the best of my knowledge and belief.\nSigned\nHATTIE OLGA WILSON"
}