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Form 600
Revised May 20, 1918
TOP SHEET
Upper portion for Divisional Record. Also see last portion of application form.
Recommended by
Pacific Division for enrollment under Requisition Siberian Service NURSE
If not American citizen, so state, and give citizenship
American Citizen
Is applicant available leaving home two weeks from date full papers are received in Washington?
Yes
Name Hazel Gertrude Bruner
Street Address
431 Second St.,
City Santa Rosa, California.
Temporary Address to what date
Please check or fill out blanks where possible.
Languages Spoken
Location of Service
Proposed length of stay
One year
E-Excellent
G-Good F-Fair
Desired
Full Volunteer
No
Volunteer with expenses met by Red Cross
No
Is allowance for living abroad to be left to discretion of foreign
Commission?
Yes
Allowance for living abroad if not left to discretion of foreign
Speaks no
Commission?
foreign
language
Salary over expense allowance, if any $70.00 per month
Allowance for living prior to departure No
Requisition for uniform and equipment
Yes
Allowance for transportation overseas and return
Yes
Allowance for transportation in U. S. and return
No
Physical Report
Age
27 yrs.
Loyalty investigation conducted by (Name of agency em-
Date Reported
Date examined
and Report
ployed, if any)
April 7, 1919
Passed -
Retail Credit Company, Insurance Bldg.,
Class A.
San Francisco, Calif.
List of Loyalty endorsements :
Frank Guerena, Humboldt Bank Bldg., San Francisco.
Dr. P.H. Meneray, Santa Rosa Bank Bldg.. Santa Rosa, Calif.
Miss Elizabeth Hogue, Lane Hospital, San Francisco, Calif.
Have passport application and pictures been forwarded
No
Date
Headquarters Record (Initial, date, and "O. K." where acceptable)
Date
File Record Referred to
Classification
Full Papers
Provisional Enrollment
War Dept.
Physical
Actual Enrollment
Remarks
Page data
- Page
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- Source index
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- Type
- photo
- Media ID
- bb2fda13de838d55
- Size
- unknown
Document data
- ID
- 2662021
- Core
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- Type
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DTO data
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Context sent to Scholar
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Page context
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"ocrText": "Form 600\nRevised May 20, 1918\nTOP SHEET\nUpper portion for Divisional Record. Also see last portion of application form.\nRecommended by\nPacific Division for enrollment under Requisition Siberian Service NURSE\nIf not American citizen, so state, and give citizenship\nAmerican Citizen\nIs applicant available leaving home two weeks from date full papers are received in Washington?\nYes\nName Hazel Gertrude Bruner\nStreet Address\n431 Second St.,\nCity Santa Rosa, California.\nTemporary Address to what date\nPlease check or fill out blanks where possible.\nLanguages Spoken\nLocation of Service\nProposed length of stay\nOne year\nE-Excellent\nG-Good F-Fair\nDesired\nFull Volunteer\nNo\nVolunteer with expenses met by Red Cross\nNo\nIs allowance for living abroad to be left to discretion of foreign\nCommission?\nYes\nAllowance for living abroad if not left to discretion of foreign\nSpeaks no\nCommission?\nforeign\nlanguage\nSalary over expense allowance, if any $70.00 per month\nAllowance for living prior to departure No\nRequisition for uniform and equipment\nYes\nAllowance for transportation overseas and return\nYes\nAllowance for transportation in U. S. and return\nNo\nPhysical Report\nAge\n27 yrs.\nLoyalty investigation conducted by (Name of agency em-\nDate Reported\nDate examined\nand Report\nployed, if any)\nApril 7, 1919\nPassed -\nRetail Credit Company, Insurance Bldg.,\nClass A.\nSan Francisco, Calif.\nList of Loyalty endorsements :\nFrank Guerena, Humboldt Bank Bldg., San Francisco.\nDr. P.H. Meneray, Santa Rosa Bank Bldg.. Santa Rosa, Calif.\nMiss Elizabeth Hogue, Lane Hospital, San Francisco, Calif.\nHave passport application and pictures been forwarded\nNo\nDate\nHeadquarters Record (Initial, date, and \"O. K.\" where acceptable)\nDate\nFile Record Referred to\nClassification\nFull Papers\nProvisional Enrollment\nWar Dept.\nPhysical\nActual Enrollment\nRemarks"
}