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-
07.
fessionally; and one at least should be well acquainted with
in private life.
You The
1. Name Min halder
Priory Road
Address
Knowle
Bristol
Occupation Principal of School
names of distinguished 2. Name Mr Wildsmith
persons should not be
given unless they really
know you well.
Address
Cotham Park
Copes
B.
344
he Colonial Office, respecting
COLONIAL NURSES.
STATEMENT for the information of the Secretary of State for the Colonies, and for record in
bins Q. 2. H. Richards.
ho is an applicant for the post of
Nurse
in the Colony of
Coltian.
Bristol
QUESTIONS.
ANSWERS.
Occupation
Will you be good enough to state how long you have been
acquainted with the applicant P
1. From about 10 years.
to
Testimonials.
Give the name, address, and occupation of the writer of each of your testimonials. Copies certified by the Colonial Nurs
The Copies may be either in MS. or in print; and From what circumstances does your knowledge of her 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.
arise ?
michell
(27F)
At Michael Clarke,
2.
She received her training
undes me.
28 Pembroke Road,
Cufton Bristol
Physician Bristol General Hospital
D. C. Raynor Esq F.R.C.S.
9
Lansdown Place
Victoria Square
Clifton - Bristol
+
How Assistant Obstetric Physician.
Bristol General Hospital.
R. G. Poole Lansdown Esq M.D.
Oakfield Road Cufton Bristol
How: Surgeon. Bristol General Hospital
While you wore acquainted with her was she
3.
a. honest ?
a.
b....
b. sober ?
c. generally well conducted ?
C.
Jee
Jes
4.
Was her health good?
yes.
f she has been employed under you, will you state the
nature of her duties, and how she discharged them ?
Fill you state the cause of her leaving-whether by voluntary resignation, dismissal, or otherwise ?
6.
5.
Thursing
in the medical o
Surgical Wards.
Training completed.
[TURN OVER.
No comments yet.
Private notes are available after approval.