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I
K
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s
FORM NO. 1
AMERICAN RED CROSS
Mrs
NURSING SERVICE
S.
APPLICATION FOR ENROLLMENT
(To be filled out entirely in applicant's handwriting)
E
2. 1. Address Name of in applicant full. 440 Elizabeth E new York Carthy Badge City Number
-
-
2
3. Date of birth San 22. 1885
Place of birth Rockland Mass,
a
4. Are you married, single or a widow ? single Are you a citizen of the United States? yes
5. Have you any physical defects? no
6. Occupation before entering Training School Saleslady
Michael
the
7. From what Training School did you graduate? Bellenge
Date april41 913
9. Character of hospital: General general Special?
8. Give location of Training School 440 E. 26th St new York City
Private?
10.
Average number of patients in Hospital during training. 1200 Length of course 2/2yrs
11. Name and address of Superintendent of Training School under whom you were trained
12. Of what nursing organizations are you a member? Belleme alumande
miss C. D. noyes 440 E. 26th St n.y. City
13.
Give name and address of Secretary anna James
14. Are you a registered nurse? ?. yes In what State? n.y Date of registration 6ct1.1913
440 E 26th St n. y. City
15. How and where have you been employed since graduation? Give information for each year
in charge of Stugical Supply Room
I have been employed at Belleme Hospital
16. In the of you willing required allegiance? yes
event war are to take the oath of
17. Name and permanent address of nearest relative Edward Mc Carthy
562 Salem
Date May 7. 1914
Signature Eleg abeth Me Carthy
4
This blank to bre sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local
to be forwarded with "credentials" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D.C.
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"ocrText": "M\nHave\nI\nK\nthere\ns\nFORM NO. 1\nAMERICAN RED CROSS\nMrs\nNURSING SERVICE\nS.\nAPPLICATION FOR ENROLLMENT\n(To be filled out entirely in applicant's handwriting)\nE\n2. 1. Address Name of in applicant full. 440 Elizabeth E new York Carthy Badge City Number\n-\n-\n2\n3. Date of birth San 22. 1885\nPlace of birth Rockland Mass,\na\n4. Are you married, single or a widow ? single Are you a citizen of the United States? yes\n5. Have you any physical defects? no\n6. Occupation before entering Training School Saleslady\nMichael\nthe\n7. From what Training School did you graduate? Bellenge\nDate april41 913\n9. Character of hospital: General general Special?\n8. Give location of Training School 440 E. 26th St new York City\nPrivate?\n10.\nAverage number of patients in Hospital during training. 1200 Length of course 2/2yrs\n11. Name and address of Superintendent of Training School under whom you were trained\n12. Of what nursing organizations are you a member? Belleme alumande\nmiss C. D. noyes 440 E. 26th St n.y. City\n13.\nGive name and address of Secretary anna James\n14. Are you a registered nurse? ?. yes In what State? n.y Date of registration 6ct1.1913\n440 E 26th St n. y. City\n15. How and where have you been employed since graduation? Give information for each year\nin charge of Stugical Supply Room\nI have been employed at Belleme Hospital\n16. In the of you willing required allegiance? yes\nevent war are to take the oath of\n17. Name and permanent address of nearest relative Edward Mc Carthy\n562 Salem\nDate May 7. 1914\nSignature Eleg abeth Me Carthy\n4\nThis blank to bre sent to applicant with circular letter and rules governing enrollment. After approval and endorsement by local\nto be forwarded with \"credentials\" (Forms Nos. 3 and 4) to the Chairman, National Committee on Red Cross Nursing Service, Washington, D.C."
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