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Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS NURSING SERVICE Name in full Commins mary Petronilla Tel. No Drexel 2161 (last) (first) (middle) Year of birth 1905 M If married, give maiden name Marital status Husband's name (single, married, widowed, divorced) 690 Dickerson Detroit mich Permanent address (street) (city) (county) (state) Probable address for the next year (street) (city) (county) (state) Give name and address of nearest relative or friend in United States: W. D. Commins brother 5419 Waketa, Washington.D.C to + (name) (relationship) (address) 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 Detrait Visiting nurse acen. P 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? BS. Public death haring a little French What languages, other than English, do you speak? Academic year (OVER)

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    "ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName in full\nCommins mary Petronilla\nTel. No Drexel 2161\n(last)\n(first)\n(middle)\nYear of birth 1905\nM\nIf married, give maiden name\nMarital status\nHusband's name\n(single, married, widowed, divorced)\n690\nDickerson\nDetroit\nmich\nPermanent address\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nW. D. Commins brother 5419 Waketa, Washington.D.C\nto\n+\n(name)\n(relationship)\n(address)\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\nDetrait Visiting nurse acen.\nP\nIndustrial\nPrivate duty\nOther (write in)\nGovernment Service:\nArmy, 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?\nBS. Public death haring\na little French\nWhat languages, other than English, do you speak?\nAcademic year\n(OVER)"
}