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Godley, Mrs. Ethel V. (B.J.) nee Ethel V. Race

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N ece- 0 a - ITT Time RED CROSS BADGE NUMBER AMERICAN RED CROSS 21594 NURSING SERVICES MILITARY SERIAL NUMBER M ANNUAL QUESTIONNAIRE - 1945 CHECK IF YOUR LAST NAME HAS CHANGED NAME (Last, first, middle) TELEPHONE NO. IF MARRIED, GIVE MAIDEN NAME 9odley Ethel U. HUSBAND'S NAME 7216 Roce Berton T. PERMANENT ADDRESS (Street, city, zone, county, state) 5 905 Pinellas st lo PRESENT ADDRESS (Street, city, zone, county, state) Cleorwa ter, Fla NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES RELATIONSHIP L DATE OF BIRTH (Month, day, year) 1-1-1885 Single Married Separated Widowed V Divorced WHAT LANGUAGES DO YOU SPEAK? YES NO English . some Italian HIGH SCHOOL GRADUATE C NAME OF COLLEGE OR DEGREE OR UNIVERSITY ATTENDED LOCATION INCLUSIVE DATES DIPLOMA MAJOR B ARE YOU CURRENTLY YES NO REGISTERED IN (State) ARE YOU CURRENTLY A MEMBER OF THE AMERICAN YES NO REGISTERED? 2 NURSES' ASSOCIATION? PRESENT EMPLOYMENT If not employed, check POSITION TITLE (H.N., P.D., inst., staff nurse, etc.) SERVICE (Medicine, surgery, etc.) - - NAME OF HOSPITAL OR ORGANIZATION ,BY WHOM EMPLOYED CITY STATE Aprella consitient Clearwates Ha HEALTH IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY Fair notable to world regol or long SERVICE hours - or do any lifting VOLUNTEER The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call to participate in a Red Cross chapter program. Please check the "Yes" ,box only if you are wi liing and able to serve if called on within the next 12 months. NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS 1. Teach home YES NO Attend an instructors' training program, if offered. (Funds are available for YES NO V nursing classes V training home nursing instructors. See local chapter.) 2. Serve in case YES NO only in home community Attend disaster institutes, if YES NO of disaster In other communities offered, in preparation for service 4 3. Teach nurse's 5. Assist/with other chapter NO YES NO 4. Accept membership on chapter cóm- YES NO YES aide classes L nittee should services be needed 2 programs, as needed If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that YES NO you will be able to serve at some time in the future? IF UNABLE TO SERVE, GIVE MAJOR REASONS 81-23-46 DATE VALUE AB A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE FAITHPOLNESS IN Aug 30 1945 SIGNATURE AND YOUR YOUR KEEPING US INFORMED OF YOUR ADDRESS. PLEASE PILL IN THIS QUESTIONNAIRE AND REfURN IT PROMPTLY TO THE CONMITTEE NAMED BELOW. ATTENTION Fill in committee name and address before sending questionnaire to nurse. SECRETARY NURSE RECRUITMENT Penellas co. chapter. COMMITTEE 78504M FORM 1045 Rev. July 1945

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Page
16
Source index
0
Type
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Media ID
4a22c3ec8114da1b
Size
unknown

Document data

ID
2661538
Core
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Type
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Context sent to Scholar

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