American Red Cross Service Application Form

Form No. 200 Revised 6-4-20 AMERICAN RED CROSS of Superseding Form 249 and com- bining with previous issue of Form 200. SERVICE APPLICATION FORM All these questions must be answered fully or the application will not be acted upon. Date guee 24 26 1. Name in full agues H von Kurowsky Telephone No Franklin 5630 2. Permanent address 1819 Gst n. W. (City) Washington D. (Number and Street) (State) 3. Temporary address, if any, to what date (Number and Street) (City) (State) 4. Name, address, and relationship of person to be notified in case of emergency (Mother) (Relationship) Mrs. than (Name) Annountry (Number 1819 and G Street) oh n.w. (City) wash D. (State) 5. (a) Date of birth. 1892 (Year) January (Month) 5 (Day) (b) Place of birth Germantown Pa. (c) If foreign born, when and where did you arrive in U. S - - 6. If foreign born, give date and court of your naturalization 7. (a) Single, married, widowed, divorced (b) Number of dependents 0 - (c) Full name of wife before marriage; or husband (d) Birthplace of wife or husband Nationality of wife or husband (e) Birthplace and nationality of father of wife or husband (f) Birthplace and nationality of mother of wife or husband (g) Full name of father Paul von Kurowsky (h) Birthplace and nationality of father Germany German (i) If father foreign born, whether naturalized, when and where naturalized in Philadelphia 1891. (j) Full maiden name of mother aguen Theodosia Holabird (k) Birthplace and nationality of mother new efork n. If american (1) If mother foreign born, whether naturalized, when and where (m) Full name and nationality of paternal grandm other Rudolf oon Kurowrky German (o) Full name and nationality of maternal grandfather Geu Samuel B Holobird american (1) Full maiden name and nationality of paternal grandmother algo oon Graeve (p) Full maiden name and nationality of maternal grandmother mary theodosia Group 8. State schools and colleges attended, with year of graduation and degrees taken Fairmaren Servinwary Wash w C 1907-1909 Library School wash al in muses 1910-1911 Belleve Training School newspate. n.y 1914-1917 - (Name) (Location) (Graduated) (Degree) 9. What is business profession Graduate nurse your present or Name of firm or corporation with which associated none an present - Duration of service Present capacity Business address (Number and Street) (City) (State) 10. (a) What previous business or professional experience have you had? 3 years previous experience in foreign service of A.K.C C 2 yrs- Social Service work Bellence Hosp new york 3 yrs. Private duty nursing Belleve Registry / yr. night supervisor - Bellence Hosp n. M. (Company) (Location) (from-to) (Nature of work) 11. As reference, give names and addresses of three American citizens not related to you mess Sarah E. Shaw TB. Social Dervice Belleves Heap new York.,1. miss marion Rocteran Supt Belleoner allieved new forbs n.y. Miam (Name) mary E Wadley Social Service Dept (City) Belleve Herp newyork.nh (Number and Street) (State)