B.
S
Mary's Hospital.
Paddington. W.
Referees
...... Name The Matron.
Give the names and addresses of two referees. They should be responsible persons who know you well, either in private life or professionally; and one at least should be well acquainted with you in private life. The
1. Address
Occupation Matron.
names of distinguished 2. Name
persons should not be
given unless they really
know you well.
• Rev Rouse. Address The Vicarage
C.O
70
23316
COLONIAL NURSES JUL 0.
01;
STATEMENT for the information of the Secretary of State for the Colonies, and for record in
the Colonial Office, respecting Miss Harriet M. Gourley
who is an applicant for the post of
Nurse
in the Colony of Hong Kong.
QUESTIONS.
ANSWERS.
Testimonials.
Walthering ham...
Occupation clergyman.
Give the name, address, and occupation of the writer of each of your testimonials. Copies certified by the Colonial Nursing Association must be sent for record in the Colonial Office. The Copies may be either in MS. or in print; and it is desirable, though not absolutely necessary, that they should be on foolscap paper not larger than this form.
(6830)
Miss Manning. (Matron)
City Hospital. Sever...
Coventry.
Miss Medill
1. Will you be good enough to state how long you have been
acquainted with the applicant?
1. From
From what circumstances does your knowledge of her
arise?
2.
June 1897 present date
Miss Gourley was trained at St Mary's Hospital Paddington
and remained as
till January 1901.
Staff
St
Mary's
Hospital. Paddington.
Brentwood. Manor House.
High Beach.
Loughton,
Dr. Burd. Medical Supt.
St Mary's Hospital.
Paddington.
Edward East. Surgeon Berkeley Cottage
Y.C.
Shillingford Wallingford.
3. While you were acquainted with her was she
3.
a. honest?
Yes
b. sober?
Yes
c. generally well conducted?
Yes
4. Was her health good?
5. If she has been employed under you, will you state the nature of her duties, and how she discharged them?
6. Will you state the cause of her leaving-whether by
voluntary resignation, dismissal, or otherwise?
(21)
4.
yes very good
probationer - Staff nurse 1. Acting Sister She discharged them faithfully
5.
6.
"Voluntary resignation
(TURN OVER.
B.
S
Mary's Hospital.
Paddington. W.
Referees
...... Name The Matron.
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- fessionally; and Que at least should be well aequainted with yon
in private life. The
1.
Address
Occupation Madron.
names of distinguished 2. Name
persons should not be
given unless they really
know you well.
• Rew Rouse. Address The Orcarage
C.O
70
23316
COLONIAL NURSES JUL 0.
01;
STATEMENT for the information of the Secretary of State for the Colonies, and for record in
the Elonial Office, respecting. Min Harrut M. Gourley
who is an applicant for the post of
Ilustrert
in the Colony of Nurse
Hory Kory
QUESTIONS.
ANSWERS.
Testimonials.
Walthering han..
Occupation car.
Give the name, address, and occupation of the writer of each of your testimonials. Copies certified by the Colonial Nursing Association must be sent for record in the Colonial Office. The Copies may be either in MS. or in print; and it is desirable, though not absolutely necessary, that they should be on foolscap paper not larger than this form.
(6830)
Miss Manning. (Matron)
City Hospital. Sever.
Coventry.
Miss Medill
1. Will you be good enough to state how long you have been
acquainted with the applicant?
1. From
From what circumstances does your knowledge of her
arise ?
2.
June 1897 present date
huse fourley was trained at St Marys Hospital Padshifter
and remained as
till January 1901-
Thure
Staff
St
Marij
Hospital. Paddington.
Brenton.
Manor House.
High Beach.
Loughton,
Dr. Burd. Medical Suppl.
St Mary's Hospital.
Paddington.
Edward East.
Surgeon Berkeley Cottage
YC.
Shillingford Wallingford.
3. While you were acquainted with her was she
3.
a. honest ?
Co
b. sober ?
Jes
c. generally well conducted ?
.........
4. Was her health good?
5. If she has been employed under you, will you state the nature of her duties, and bow she discharged them?
6. Will you state the cause of her leaving-whether by
voluntary resignation, dismissal, or otherwise?
(21)
4.
5.
yes very good
probationer - Happ nurse 1. Acting Listers She discharged them faithfully
6.
" Voluntary resignation
(TURN OVER.
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