tive habits?

7. General health?

8. Has she flat feet, hammer-toe, or any other defect?

9. Is her vision good in each eye?

10. Is her hearing perfect?

11. Has she sound teeth, and if not, have they been properly
attended to by a Dentist lately?

12. Has she shown any tendency to Rheumatism, Anaemia,
Tuberculosis, or other illness?

13. When?

14. What?

15. Has she ever had influenza?

16. Does she suffer from headaches?

17. Any form of fits?

18. Heart disease or varicose veins?

19. Is she subject to any functional disturbance?

* * * * *

I have on the day of 191 seen and
examined and
hereby certify that she is apparently in good health, that she
is not labouring under any deformity, and is, in my opinion,
both physically and mentally competent to undertake duty in
a Military Hospital, and is [*]A. Fit for General Service.
B. Fit for Home Service only.
C. Unfit.

_Date (Signed)
Address_

[Footnote *: Kindly delete categories which do not apply.]

* * * * *

Reference No.: J.W. 19c.

JOINT WOMEN'S V.A.D. DEPARTMENT.
Territorial Forces Association. British Red Cross Society. Order of St.
John of Jerusalem.
DEVONSHIRE HOUSE, PICCADILLY, LONDON. W1.

* * * * *

QUALIFICATIONS
of Members of Women's Voluntary Aid Detachments for Nursing Service or
General Service.

* * * * *

1. (a) Name in full (_Mrs. or Miss_).
(b) If Married state Maiden Name.

2. Permanent Postal Address.
Present Postal Address.

3. Telephone No.

4. Telegraphic Address.

5. Detachment County and No.
B.R.C.S.
St. John Brigade.
St. John Association.

6. Name and Address of Commandant of Detachment.

7. Rank in Detachment.

8. Time of Service in Detachment.

9. Age and Date of Birth.

10. Place and Country of Birth.

11. Nationality at Birth.

12. Present Nationality.

13. Height.

14. Weight.

15. Where Educated.

16. At what age did you leave school?

17. Whether Single, Married, or Widow.

18. If not Single, state Nationality of Husband.

19. Name and Address of Next-of-Kin or Nearest Relation
residing in the British Isles.

20. Father's Nationality at Bir