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Regised 6420
Form 200
Superseding Form 249 and com
AMERICAN RED CROSS
C
bining with previous issue of
Form 200.
SERVICE APPLICATION FORM
B
All these questions must be answered fully or the application will not be acted upon.
Date. Name July in full 16-1924 Clara Edith Du Brau
1.
2.
Permanent address 9/0 uns. Street) W. Herfert Caswell (City) narragansett Pier Phone sland
Telephone Nollining 4570
(Number and
3. Temporary address, if any, to what date. Rhode Island Hospital
(State)
June of learning )
Providence Rhodulaland
(Number and Street
(City)
C
(State)
4. Name, address, and relationship of person to be notified in case of emergency
sister (Relationship) mu. 11. : Herkert (Name) Caswell (Number marraganiett and Street) Pree R.I. (City) P.O.Boy (State) 373
5. (a) Date of birth. (Year) July (Month)
1881
13
(b) Place of birth Versailles Conecticut
(Day)
(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. sungle
(b) Number of dependents
d
(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
(receased) Gustave gu Bran
(i) If Birthplace father foreign and nationality born, whether of father naturalized, Berring when and where new French york - German city
(h)
(j) Full maiden name of mother
anna mary Bessettes
(k) Birthplace and nationality of mother
French - perman
(1) If mother foreign born, whether naturalized, when and where
(m) Full name and nationality of paternal grandn martin
new - City Strench
(n) Full maiden name and
nationality of paternal grandmother Elizabeth charmiel German
(o) Full name and nationality of maternal grandfather
George Bessette
french
(p) Full maiden name and nationality of maternal grandmother
Janna Franium German
8. State schools and colleges attended, with year of graduation and degrees taken
(Grammar High Schere
Rhode Island Hospital trauning Schenkfor nurses
Devember 18- 1914 Pronedence R.I.
(Name)
(Location)
(Graduated)
(Degree)
9. What is your present business or profession
nurse
Name
of
firm or corporation with which associated Rhide I aland Hospital
Duration
Business of address service Rhode year 2 Instand mus. Hospital Present Prinduse capacity assistant Rhode Super Island
(Number and Street)
(City)
(State)
10. (a) What previous business or professional experience have you had?
2nd assist sept R. I. Hospital wr.18-1914 July/-1916
Louidale will foundale R. I. Sept. 1916 Kno.1-1917 hudsthialluure
new England Hospital Boston wass Juivy years
Hospital cardiff Wales
un.
assist
sentran child helfare seha July 1921-june/1922
chief "
!!
(Company)
(Liceation)
(from-to)
(Nature of work)
11. As reference, give names and addresses of three American citizens not related to you
nies Charlotte Brown 116 South main St athol mass
Dr. J.M. Peters R.I. Hospital Princidence Rhade Island
5
Dr. Letetia adams T.2 commonweath are Boston mass.
4
(Name)
(Number and Street)
(City)
(State)
Page data
- Page
- 82
- Source index
- 0
- Type
- photo
- Media ID
- 5e590baf550c7883
- Size
- unknown
Document data
- ID
- 2661393
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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Page context
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"ocrText": "I\nRegised 6420\nForm 200\nSuperseding Form 249 and com\nAMERICAN RED CROSS\nC\nbining with previous issue of\nForm 200.\nSERVICE APPLICATION FORM\nB\nAll these questions must be answered fully or the application will not be acted upon.\nDate. Name July in full 16-1924 Clara Edith Du Brau\n1.\n2.\nPermanent address 9/0 uns. Street) W. Herfert Caswell (City) narragansett Pier Phone sland\nTelephone Nollining 4570\n(Number and\n3. Temporary address, if any, to what date. Rhode Island Hospital\n(State)\nJune of learning )\nProvidence Rhodulaland\n(Number and Street\n(City)\nC\n(State)\n4. Name, address, and relationship of person to be notified in case of emergency\nsister (Relationship) mu. 11. : Herkert (Name) Caswell (Number marraganiett and Street) Pree R.I. (City) P.O.Boy (State) 373\n5. (a) Date of birth. (Year) July (Month)\n1881\n13\n(b) Place of birth Versailles Conecticut\n(Day)\n(c) If foreign born, when and where did you arrive in U. S\n6. If foreign born, give date and court of your naturalization\n7.\n(a) Single, married, widowed, divorced. sungle\n(b) Number of dependents\nd\n(c) Full name of wife before marriage; or husband\n(d) Birthplace of wife or husband\n+\nNationality of wife or husband\n(e) Birthplace and nationality of father of wife or husband\n(f) Birthplace and nationality of mother of wife or husband\n(g) Full name of father\n(receased) Gustave gu Bran\n(i) If Birthplace father foreign and nationality born, whether of father naturalized, Berring when and where new French york - German city\n(h)\n(j) Full maiden name of mother\nanna mary Bessettes\n(k) Birthplace and nationality of mother\nFrench - perman\n(1) If mother foreign born, whether naturalized, when and where\n(m) Full name and nationality of paternal grandn martin\nnew - City Strench\n(n) Full maiden name and\nnationality of paternal grandmother Elizabeth charmiel German\n(o) Full name and nationality of maternal grandfather\nGeorge Bessette\nfrench\n(p) Full maiden name and nationality of maternal grandmother\nJanna Franium German\n8. State schools and colleges attended, with year of graduation and degrees taken\n(Grammar High Schere\nRhode Island Hospital trauning Schenkfor nurses\nDevember 18- 1914 Pronedence R.I.\n(Name)\n(Location)\n(Graduated)\n(Degree)\n9. What is your present business or profession\nnurse\nName\nof\nfirm or corporation with which associated Rhide I aland Hospital\nDuration\nBusiness of address service Rhode year 2 Instand mus. Hospital Present Prinduse capacity assistant Rhode Super Island\n(Number and Street)\n(City)\n(State)\n10. (a) What previous business or professional experience have you had?\n2nd assist sept R. I. Hospital wr.18-1914 July/-1916\nLouidale will foundale R. I. Sept. 1916 Kno.1-1917 hudsthialluure\nnew England Hospital Boston wass Juivy years\nHospital cardiff Wales\nun.\nassist\nsentran child helfare seha July 1921-june/1922\nchief \"\n!!\n(Company)\n(Liceation)\n(from-to)\n(Nature of work)\n11. As reference, give names and addresses of three American citizens not related to you\nnies Charlotte Brown 116 South main St athol mass\nDr. J.M. Peters R.I. Hospital Princidence Rhade Island\n5\nDr. Letetia adams T.2 commonweath are Boston mass.\n4\n(Name)\n(Number and Street)\n(City)\n(State)"
}