A.
Brivale
Application for Employment as Rator Nurse in the Colonies.
Form to be filled up by the Applicant herself, and sent to the Private Secretary to the Secretary of State, Colonial Office, London, by the Colonial Nursing Association.
Name in full
Dafe
Date of Application
Profession or Occupation
Address
Father's Name
Xaude Mary Wood
4. 11. 12
hurse
35155
298
RECO [REGO 6 NOV 12
nurse's Home. Loncin Hospital. Whilichapel. f
Profession or Occupation|
Address ...
If dead, his Name and Profession
should nevertheless be given.
Day and year of birth...
Place of birth
Chris Oples boot.
Jarmes
Barugh House. Pickering. Yorkshire
29 July 1883
Age last birthday 29
Sosilk Holme-Shingle Yorkshire. (Hoving hams)
Whether single, married, or a widow
Number of children
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.
Professional qualifi-
cutions, and the
place and date at
which each was obtained
Sons
Daughters
Single
Aged respectively
35
Werande House School King's Lynn. For folde
Betweene Ki age of 11-17 years.
Quis foapital for Children, Hacking Road R. d
September 1903 December 1906
London Hapital. White chapel. &
May 1984. July 1911
Certificate of Central Midwives Bound
Fib
19/2
Employment from on Hospital Maternity Certificate
completion of edu- cation to present time
Mention each position held by you, the dates between which you held
it, and the cause of leaving; and what Balary you are now receiving.
Appointment desired
If you do not apply for a particular appointment, you should state to what Colonies you would go, and what is the lowest salary that you would accept.
& L (350&)-10481-500-7-3
(J. 6.)
bet 19h
Jau 1912.
Between leaving school and going by s Quen's Hospital for Children I lived at home. I am at present sull attacked to the Loncion Areptil Private nursing Staff.
£30.
Government Calch Hospital (Biale; druese)
động đồng.
(TURN OVER.
Page 300Page 301
Referees
Give the names and ad- dresses of two referees. They should be respon- sible persons who know
you
well, either in
private life
Or pro-
1. Name
Address
Mrs Bent worth Bethaus
fessionally; and one Occupation
at least should be well
acquainted with you
in private life.
The
names of distinguished 2. Name
persons should not be
Malton
Yorkshire
Lady
Mis's Moore
given unless they really
know you well,