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Forename:
Surname:
Address:
County:
Age when engaged:
Character:
Service from:
Service to:
Hospital:
Previous engagement:
Rank at engagement:
Date of engagement:
Pay at engagement:
Rank at termination:
Date of termination:
Pay at termination:
Particulars of duties:
Whole or part time:
Additional information:
Department:
Commission:
Certificate no:
Honours awarded:
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