Name in full
Date of Application
Profession or Occupation
Address
Father's Name
Luer maria Jacobs
August 27th 1904
Trained Nurse
310 nos Silvester 11 London Road St. Albans.
Henry Jacobo Aquiculturist Dorchester Ozon
If dead, his Name and Profession
Day and year of birth
Place of birth
Whether single, married, or a widow
Number of children
Sons
Daughters
Henry Jacobs Aquiculturist Dorchester Ozon
January 13th 1871.
Doseliester
Single.
Aged respectively
Education
Mention the Schools or Colleges at which you received your education, professional as well as general; and give in Each case the date of entry and leaving.
Dorchester School, from :801) and rate fuction at intéwals Intecals Till 1901.
General Training at Kings College Hospital from August 15, 1894 August i 1897.
Medivifay training at Pictish deyimp in Hospital from Debruary. 3. 1904 till afil 30% 1904
Professional qualifications, and the place and date at which each was obtained
Trained Vicurse Kings College Hospital August 1 1897.
Cast: London Obstetrical Society thay 26 1904.
Employment from completion of education to present time
ieution each position held by you, the dates between which you held and the cause of learing; and what alary you are reviving.
Staff Nurse, Hospital Samaritano São Paulo, Brazil, from March 1595 till Pharele 1901.
Nation Hospital Samaritano São Paulo, Brazil from Thanche 1450. till September 1903, resiqued to return to England
Salary £120.0.0.
Temporary works is Private Nurse from Doecember till selvenery, and from June Tell August 19ou when waiting for vacancy as cleidinger pupil and Civil Hospital - Hong. Rong.
B & L (2502)—10481-500-7-3
(J. 6.)
Age last birthday 33 years
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