th.

21. Mother's Nationality at Birth.

22. Father's Profession.

23. Religion.

24. (a) If you volunteer for nursing duties state what experience
you have had in wards.

(b) Name and address of hospital.

(c) Date.

25. Certificates held.

26. (a) Nursing. (f) Motor Driver.
(b) Kitchen. (g) Laboratory Attendant.
(c) Clerical. (h) X-Ray Attendant.
(d) Storekeeping. (i) House Work.
(e) Dispenser. (j) Pantry Work.

27. State what experience and qualifications you have had
for Categories in No. 26.

28. Have you been inoculated against Enteric Fever?
If so, what date?
If not, are you willing to be?

Have you been vaccinated?
It so, what date?
If not, are you willing to be?

29. Your usual Occupation or Profession?
Your present Occupation or Profession?

30. Give the Names and Addresses of two British Householders with
permanent addresses in the British Isles who have known applicant for
two or more years, but are not related to applicant, to act as
References, having previously obtained their permission to use
their names.

(a) (Mayor, Magistrate, Justice of the Peace, Minister of Religion,
Barrister, Physician, Solicitor or Notary Public).
Acquaintance dating from year ________
(b) Lady.
Acquaintance dating from year _______

31. Name and Address of Head of College or School, recent Business
Employer, Head of Government Department, Secretary of Society or some
other person who can be referred to for a report on your
qualifications for the work selected. (The Quartermaster of your
V.A.D. could be given if you have worked in her department.)

In what capacity employed?

How long employed?
Year?

32. Are you willing to serve at home or abroad?

33. Are you willing to serve in Civil Hospitals from which
personnel have been withdrawn for War Service?

34. Are you willing to serve:--

(a) With pay,
(b) For expenses only,
on the terms of service laid down in our terms of service?

N. B.--Members who can afford to work for their expenses only are
urgently needed.

35. Date after which you will be available for duty.

36. (a) Are you pledged to serve in any other organisation?
(b) If so, what?

37. (a) Have you served with the Women's Legion or any
similar organisation?
(b) If so, what?

I he