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Clar Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS Clarke NURSING SERVICE (last) mary aun M Name in full (first) (middle) Tel. No. Trinity 9784 a If married, give maiden name Year of birth 1854 a Marital status Husband's name (single, married, widowed, divorced) Permanent address D Probable for the next address year Christ (street) (city) Hospital 49th (county) monument (state) are (street) (city) (county) (state) Give name and address of nearest relative or friend in United States: Frances aidarke (name) (relationship) niece 916 (address) St. Phila delphic, Pa 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 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- 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) Psychiatric Nursing Operating room Anaesthesia Public health nursing 2. Have you taken any courses in a college or university? 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 In what major field was above study? What languages, other than English, do you speak? * 'Academic year (OVER)

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Document source extras
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        "month": 2,
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    "ocrText": "Clar\nForm 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nClarke\nNURSING SERVICE\n(last)\nmary\naun\nM\nName in full\n(first)\n(middle)\nTel. No. Trinity 9784\na\nIf married, give maiden name\nYear of birth 1854\na\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nPermanent address\nD\nProbable\nfor the next\naddress year Christ (street) (city) Hospital 49th (county) monument (state) are\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nFrances aidarke (name) (relationship) niece 916 (address) St. Phila delphic, Pa\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\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? One\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\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)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing\n2. Have you taken any courses in a college or university?\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\nIn what major field was above study?\nWhat languages, other than English, do you speak?\n* 'Academic year\n(OVER)"
}