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 fessionally; and one at least should be well acquainted with you in private life.
The
1. Name
Address
miss I. Bentley
Occupation
namics of distinguished 2. Name
persons should not be
given unless they really
know you well.
Address
so I am cores fouth Informary
Brad
W
In atron St Pancras Zximary -)
Rev. W. Law.
Ryous Rectory
Iceton
Biola.
Durham
Occupation
Rector of Parish-
B.
COLONIAL NURSES.
278
STATEMENT for the information of the Secretary of State for the Colonies, and for record
in the Colonial Office, respecting as I. Bagley
who is an applicant for the post of
Metrotr Nurse
in the Colony of
QUESTIONS.
1. Will you be good enough to state how long you have
been acquainted with the applicant?
ANSWERS.
Testimonials.
Give the name, address, and occupation of the writer of each of your testimoniala. Copies certified by the Colonial Nursing Association must be sent for record in the Colonial Office. The Copies may be either in M.S. or in print; and it a desirable, though not absolutely necessary, that they should be on foolscap paper not larger than this form.
2. From what circumstances does your knowledge of her
arise?
(644x)
3. While you were acquainted with her was she
1. From.
2.
10
11-1913
Jan. 24: 1914.
from
Jeneral supermisions of her work & conduct during her period of tracking + later, while performich wing bauperarily of ward Sister for 3 mouths.
the during
3.
(a). bonest ?
a.
(b). sober?
yes.
b.
(c). generally well conducted ?
c. We
4. Was her health good?
4.
yees. nccellent
2. If she has been employed under you, will you state the
nature of her duties, and bow she discharged them ?
h.
Brokatunion Nurse. 3 years.
very good". Tempt. Sicher
3 monthn
very good!
6. Will you state the cause of her leaving-whether by
voluntary resignation, dismissal, or otherwise ?
G.
The left when her terin
of training
was completed.
To qualify for ster Cm B. Certificats which she now holds,
[TURN OVER.
No comments yet.
Private notes are available after approval.