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I
Confidential
Please return
Hawaii - Himic K-Mansing Service
FORM 1219
Mrs.
REV.JUNE 1942
AMERICAN RED CROSS
APPLICATION FOR EMPLOYMENT - NURSING PERSONNEL
Address
I. PERSONAL
Badge (No.
117669
That
8,
Name in fullMrs. Ruth Daum (Fonest Ruth Guthrie.).
(MISS OR MRS.)
(H.D. 7669
(IF MARRIED, GIVE MAIDEN NAME ALSO)
Not enrolled
Present address. 286. Cleveland Ave, Ashland, Ohio
(STREET)
Tel. No 775 Main
(CITY)
(STATE)
5309
Permanent address R.B. #I Crestline Ohio
Tel. No
(STREET)
(CITY)
(STATE)
Citizenship U.S.A.
Color White
Place of birth Hayesville, Ohio.
Present position Public Health Nurse $2300.per VI, Date of birth
(TITLE)
at
(SALARY)
Ashland County General Health
Single
Widowed
(ORGANIZATION)
h
(ADDRESS)
Married
Divorced
II. PROFESSIONAL STATUS
States registered
Ohio
Current registration
Ohio 6389
To what professional organizations do you belong?
If not an enrolled Red Cross nurse, has your application for enrollment been submitted to
your Local Committée Red Cross Nursing Service? (NOT chapter committee)
0
When and to whom?
T
e
III. EDUCATION
s
1. Prior to entering school of nursing:
Name
City and State
Dates
iploma-Degree
High School
Jeromesville
Major
Jeromesville
0
I9I4
Diploma
Normal School
University
Other
2. School of nursing from)
Flower Hospital
Toledo
Ohio
which you graduated)
(NAME)
(CITY)
(STATE)
Length of course
5 years
3 years
(Specify other)
Date completed
3. Undergraduate affiliations:
Hospital or Organization
City and State
Clinical Specialty No. Months
(1)
(2)
(3)
I
4. Postgraduate clinical courses: (Do not include academic work or employment.)
Hospital or Organization
City and State
Clinical Specialty
Dates
(1)
(2)
(3)
J
5. Academic study since graduation from school of nursing:
6
College or University
City and State
Academic years
No. Points
(1) Western Reserve
Cleveland Ohio
I928
Ashland, Ohio
1929-1930
go
6
(2) Aghland College
(3)
Page data
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- Source index
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- Type
- photo
- Media ID
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Document data
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- Core
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- Type
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"ocrText": "I\nConfidential\nPlease return\nHawaii - Himic K-Mansing Service\nFORM 1219\nMrs.\nREV.JUNE 1942\nAMERICAN RED CROSS\nAPPLICATION FOR EMPLOYMENT - NURSING PERSONNEL\nAddress\nI. PERSONAL\nBadge (No.\n117669\nThat\n8,\nName in fullMrs. Ruth Daum (Fonest Ruth Guthrie.).\n(MISS OR MRS.)\n(H.D. 7669\n(IF MARRIED, GIVE MAIDEN NAME ALSO)\nNot enrolled\nPresent address. 286. Cleveland Ave, Ashland, Ohio\n(STREET)\nTel. No 775 Main\n(CITY)\n(STATE)\n5309\nPermanent address R.B. #I Crestline Ohio\nTel. No\n(STREET)\n(CITY)\n(STATE)\nCitizenship U.S.A.\nColor White\nPlace of birth Hayesville, Ohio.\nPresent position Public Health Nurse $2300.per VI, Date of birth\n(TITLE)\nat\n(SALARY)\nAshland County General Health\nSingle\nWidowed\n(ORGANIZATION)\nh\n(ADDRESS)\nMarried\nDivorced\nII. PROFESSIONAL STATUS\nStates registered\nOhio\nCurrent registration\nOhio 6389\nTo what professional organizations do you belong?\nIf not an enrolled Red Cross nurse, has your application for enrollment been submitted to\nyour Local Committée Red Cross Nursing Service? (NOT chapter committee)\n0\nWhen and to whom?\nT\ne\nIII. EDUCATION\ns\n1. Prior to entering school of nursing:\nName\nCity and State\nDates\niploma-Degree\nHigh School\nJeromesville\nMajor\nJeromesville\n0\nI9I4\nDiploma\nNormal School\nUniversity\nOther\n2. School of nursing from)\nFlower Hospital\nToledo\nOhio\nwhich you graduated)\n(NAME)\n(CITY)\n(STATE)\nLength of course\n5 years\n3 years\n(Specify other)\nDate completed\n3. Undergraduate affiliations:\nHospital or Organization\nCity and State\nClinical Specialty No. Months\n(1)\n(2)\n(3)\nI\n4. Postgraduate clinical courses: (Do not include academic work or employment.)\nHospital or Organization\nCity and State\nClinical Specialty\nDates\n(1)\n(2)\n(3)\nJ\n5. Academic study since graduation from school of nursing:\n6\nCollege or University\nCity and State\nAcademic years\nNo. Points\n(1) Western Reserve\nCleveland Ohio\nI928\nAshland, Ohio\n1929-1930\ngo\n6\n(2) Aghland College\n(3)"
}