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ere
ar
a
+
e
2md
J
Form 1045
Rev. Nov. 1942
ama wouan AMERICAN RED CROSS AHT SVITAS: we
TI
zon
NURSING SERVICE
If you have changed your last name since
contacting us, please check here
Mrs
Name in full Dushane (last) , June (first) marjeanne (middle)
Tel. No. 8-4187
If married, give maiden name
Date of
Marital status
Single
Husband's name
(single married, widowed, divorced)
michigan
M
Ju
Permanent address 308 Heengerford (stregt) marquette (county)
(state)
for the next year 432 Livingston, (street) N.E. grand lapic (city)
Probable address
Kent
michigan
Mary
(county)
(state),
Give name and address of nearest relative or friend in United States:
Mr. Mrs.,Frank (name) Aushane (relationship) - parents Henegroford address) Ave, Regarney
Are you employed in nursing at the present time?
Yes
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
Institutional
Butterworth Hospital, Grand Rapids, mich
Public health
Industrial
I
Private duty
Other (write in)
a
Government Service: Army, Regular
Navy, Regular
Veterans Administration
S
Reserve
Reserve
Children's Bureau
5
U.S.P.H. Service
U.S. Indian Service
MAJOR RESPONSIBILITIES
Administration
Teaching
Private duty
of present employment
S
Supervision
General staff
Other (specify)
If not employed, what type of nursing would you prefer to render?
General
staff
e
How many years did you attend HIGH SCHOOL?
One
Two
Three
Four
Graduated
Yes
No
Before entering training, how many years did you attend COLLEGE? none
Did you have a five-year course granting bachelor's degree? No
AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-
Postgraduate course
in a hospital
Experience in hospital
1. A postgraduate course or experience in any of the following services? (at least 3 months)
(at least 6 months)
Communicable disease nursing (include tuberculosis)
Psychiatric nursing
Operating room
Anaesthesia
2. Have you had any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
Ph.D.
M. D.
one academic year
year
years
years
years
degree
degree
degree
degree
10,
In what major field was above study?
3. Training and experience in the public health field: Postgraduate 4 months or more
Certificate
Degree
Experience 6 months
Have you ever held a position as an air hostess?
Yes
No
How long?
Have you ever had any other air experience?
Yes
No
Specify
(OVER)
Page data
- Page
- 37
- Source index
- 0
- Type
- photo
- Media ID
- 216909e94c1f809c
- Size
- unknown
Document data
- ID
- 2661222
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source metadata
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Document source extras
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Page context
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"ocrText": "ere\nar\na\n+\ne\n2md\nJ\nForm 1045\nRev. Nov. 1942\nama wouan AMERICAN RED CROSS AHT SVITAS: we\nTI\nzon\nNURSING SERVICE\nIf you have changed your last name since\ncontacting us, please check here\nMrs\nName in full Dushane (last) , June (first) marjeanne (middle)\nTel. No. 8-4187\nIf married, give maiden name\nDate of\nMarital status\nSingle\nHusband's name\n(single married, widowed, divorced)\nmichigan\nM\nJu\nPermanent address 308 Heengerford (stregt) marquette (county)\n(state)\nfor the next year 432 Livingston, (street) N.E. grand lapic (city)\nProbable address\nKent\nmichigan\nMary\n(county)\n(state),\nGive name and address of nearest relative or friend in United States:\nMr. Mrs.,Frank (name) Aushane (relationship) - parents Henegroford address) Ave, Regarney\nAre you employed in nursing at the present time?\nYes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nButterworth Hospital, Grand Rapids, mich\nPublic health\nIndustrial\nI\nPrivate duty\nOther (write in)\na\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nS\nReserve\nReserve\nChildren's Bureau\n5\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nS\nSupervision\nGeneral staff\nOther (specify)\nIf not employed, what type of nursing would you prefer to render?\nGeneral\nstaff\ne\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nBefore entering training, how many years did you attend COLLEGE? none\nDid you have a five-year course granting bachelor's degree? No\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-\nPostgraduate course\nin a hospital\nExperience in hospital\n1. A postgraduate course or experience in any of the following services? (at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include tuberculosis)\nPsychiatric nursing\nOperating room\nAnaesthesia\n2. Have you had any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\nM. D.\none academic year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\n10,\nIn what major field was above study?\n3. Training and experience in the public health field: Postgraduate 4 months or more\nCertificate\nDegree\nExperience 6 months\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\nHave you ever had any other air experience?\nYes\nNo\nSpecify\n(OVER)"
}