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; Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS NURSING SERVICE Name in full Campbez - Mary Isabez Tel. No. Drange 5- 1886 (last) (first) (middle) If married, give maiden name Year of birth 189H Marital status Single Husband's name (single, married, widowed, divorced) Permanent address Central Rd Widdlebury NEW Haven Cours H (street) (city) (county) (state) for the next year 85 Ealiou Place East Orange ESSEX Probable address NEW Jersey (street) (city) (county) (state) Give name and address of nearest relative or friend in United States: Mrs E Pampbell (mother) P.D.Box18 . Peulra Rd Middlebury (name) (relationship) (address) Connecticut Are you employed in nursing at the present time? Yes No PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed Institutional Public health Industrial Private duty Cultral Registry Hilyer Streey Drange N.J. Other (write in) Government Service: Army, Regular Navy, Regular Veterans Administration Reserve Reserve Children's Bureau U.S.P.H. Service U.S. Indian Service MAJOR RESPONSIBILITIES Administration Teaching Private duty of present employment Supervision General Staff Other (specify) How many years did you attend HIGH SCHOOL? One Two Three Four Graduated Yes No SINCE GRADUATION FROM YOUR SCHOOL OF NURSING have you ever had- sper ORAM 1. A postgraduate course or experience in any of the following special services? Postgraduate course Experience in hospital in a hospital or public health field (at least 3 months) (at least 6 months) Communicable disease nursing (include Tbc) 1ycar Psychiatric Nursing W Operating room Anaesthesia Public health nursing 5, 2. Have you taken any courses in a college or university? a Less than One Two Three Four Bachelor's Master's P.H.D. Certificate in *one year year years years years degree degree degree Public Health a 6 In what major field was above study? What languages, other than English, do you speak? NoNe State Academic year (OVER)

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    "ocrText": ";\nForm 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName in full Campbez - Mary Isabez\nTel. No. Drange 5- 1886\n(last)\n(first)\n(middle)\nIf married, give maiden name\nYear of birth\n189H\nMarital status\nSingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address Central Rd Widdlebury NEW Haven\nCours\nH\n(street)\n(city)\n(county)\n(state)\nfor the next year 85 Ealiou Place East Orange ESSEX\nProbable address\nNEW Jersey\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nMrs E Pampbell (mother) P.D.Box18 . Peulra Rd Middlebury\n(name)\n(relationship)\n(address)\nConnecticut\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nIndustrial\nPrivate duty\nCultral Registry\nHilyer Streey\nDrange N.J.\nOther (write in)\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\nsper ORAM\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\n1ycar\nPsychiatric Nursing\nW\nOperating room\nAnaesthesia\nPublic health nursing\n5,\n2. Have you taken any courses in a college or university?\na\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\na\n6\nIn what major field was above study?\nWhat languages, other than English, do you speak?\nNoNe\nState\nAcademic year\n(OVER)"
}