Referees
Give the names and ad- dresses of two referees. They should be respon- sible persons who know you well, either in private life pro- fessionally; and one at least should be well acquainted with you
in private life. The
1. Name
Address
Occupation
names of distinguished 2. Name
persons should not be
given unless they really
The Rev. Edmund Ibbotson
St. Albans, Herts.
Chaplain
Deerford House, Deerford Road
3. St Albans Herts.
Others K' Ħ tout?
King's College Hospital
know you well.
Testimonials.
1.
B
COLONIAL NURSES.
0.0.
130016
RECE
530
[Ref 1 SEP 04]
STATEMENT for the information of the Secretary of State for the Colonies, and for record in
Miss L. M. Jacobs.
the Colonial Office, respecting
who is an applicant for the post of
Minimum Nurse
in the Colony of
"Lincoln's Den Helds. Wo.e.
QUESTIONS.
Nation
Occupation
Address
Give the name, address, and occupation of the writer of each of your testimonials. Copies certified by the Colonial Nursi
The Copies may be either in MS, or in print: and Association must be sent for record in the Colonial Office. desirable, though not absolutely necessary, that they should be on foolscap paper not larger than this form.
Mr. Cameron
Matron Brook!.
(27F)
The Rev. I Should Watro 154-8 erlang Rot. S Kings College Hospital Lincotus Que Fields We
W. Loudon Shaw Esq Mr. B. Senior Medical Off
Hospital Samaritans Sao Paulo. Prazil.
tor Lauriston J. Lane. Assistant Medical Offices
ta Veridiana, São Paulo. Terazil
Pua
Da
& Tracdonald Ery. Sccretary Horp: Sama The Quitanda. 3. São Paulo, Brazil.
A. C. Wichtens Esq. Secretary
British Lying in Hospital. Endell Street 10
rudon Obstetrical Society
10 Harves
Square W.
W Handfield Jones. Th. W. Hon Secretary.
Will you be good enough to state how long you have been
acquainted with the applicant ?
From what circumstances does your knowledge of her
arise ?
1. From
2.
to.........
Hong Kong
Civil Hospital
ANSWERS.
her litt
the forement time.
Any. 1904.
I lodged with her Father mother, when Civata at Dnchester, Oxon. I hans soxtete the circumstance of her life work ever since axeen her prepently quite latity.
While you were acquainted with her was she
3.
a. honest ?
ᏓᏆ .
b. sober?
b.
c. generally well conducted ?
Was her health good ?
If she has been employed under you, will you state the
nature of her duties, and how she discharged them ?
Will you state the cause of her leaving--whether by
voluntary resignation, dismissal, or otherwise?
4.
"Yes-
5. No.
6.
yes yes yo.
[23]
[TURN OVER.
Referees
Give the names and ad- dresses of two referees. They should be respon- sible persons who know you well, either in private life pro- fessionally; and one nt least should be well acquainted with you
in private life. The
1. Name
Address
Occupation
names of distinguished 2. Name
persons should not be
given unless they really
The Reo Ederund Ibbotson
decurford House, decurford Road
3. Albans Herts.
Chaplain
thers K' Ħ tout?
King's College Hospital
know you well.
Testimonials.
1.
B
COLONIAL NURSES.
0.0.
130016
RECE
530
[Ref 1 SEP 04!
STATEMENT for the information of the Secretary of State for the Colonies, and for record in
Miss L. M. Jacobs.
he Colonial Office, respecting
ho is an applicant for the post of
Minimum Nurse
in the Colony of
"Lincoln's Den Helds. Wo.e.
QUESTIONS.
Nation
Occupation
Address
Give the name, address, and occupation of the writer of each of your testimonials. Copies certified by the Colonial Nursi
The Copies may be either in MS, or in print: and Association innst be sent for record in the Colonial Office. desirable, though not absolutely necessary, that they should be on foolscap paper not larger than this form.
Mr. Cameron
matron Brook!.
(27F)
Then R I Should Watro 154-8 erlang Rot. S Kings College Hospital Lincotus Que Fields We
W. Loudon Shain Esq Mr. B. Senior Medical Off
Hospital Samaritans Sao Paulo. Prazil.
tor Lauriston J. Lane. Assistant Medical Offices
ta Veridiana, São Paulo. Terazil
Pua
Da
& Tracdonald Ery. Sccretary Horp: Sama The Quitanda. 3. São Paulo, Brazil.
A. C. Wichtens Esy. Secretary
Pritisk Lejing in Hospital. Endell Street 10
rudon Obstetrical Society
10 Harves
Square W.
W Handfield Jones. Th. W. Hon Secretary.
Will you be good enough to state how long you have been
acquainted with the applicant ?
From what circumstances does your knowledge of her
arise ?
1. From
2.
to.........
Hong Kong
Civil Hospital
ANSWERS.
her hitt
the forement time.
Any. 1904.
I lodged with her Father mother, when Civate at Dnchester, Oxon. I hans soxtete the circumstance of her life work ever since axeen her prepently quite latity.
While you were acquainted with her was she
3.
a. honest ?
ᏓᏆ .
b. sober?
b.
c. generally well conducted ?
Was her health good ?
If she has been employed under you, will you state the
nature of her duties, and how she discharged them ?
Will you state the cause of her leaving--whether by
voluntary resignation, dismissal, or otherwise?
4.
"Yes-
5. No.
6.
yes yes yo.
[23}
[TURN OVER.
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