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Form 1045
Rev. Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
Name in full Sara (last) m Gray
Tel. No. Gr 7.4536
(first)
(middle)
If married, give maiden name
Year of birth 1886
Marital status
Husband's name
(single, married, widowed, divorced)
Permanent address % mrs m Snedden 2256202 St- City
(street)
(city)
(county)
(state)
Probable for the next address year 63265St NY
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
her m (name) warmright. (relationship) Sister. Bengham Hall (address) Hrg. Canandaigna my
Are you employed in nursing at the present time? Yes
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
Institutional
Virginnia Day nursed 632 E 5 st. ng.ct
Public health
Industrial
Private duty
Other (write in)
Social service 18yrs
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 in of the following special services? no.p.g
postgraduate course or experience any
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 Experience
4yr
Anaesthesia
6 miths
Public health nursing writing hurning
2. Have you taken any courses in a college or university?
no
Less than
One
Two
Three
Four
Bachelor's
Master's
P.H.D.
*one year
year
years
years
years
degree
degree
A
Certificate in
degree
Public Health
In what major field was above study?
Tom none infect
I
What languages, other than English, do you speak?
Academic year
(OVER)
5-18-43 K,C,
Page data
- Page
- 3
- Source index
- 0
- Type
- photo
- Media ID
- 5e9fdfe4f265e23f
- Size
- unknown
Document data
- ID
- 2661552
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source metadata
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Document source extras
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"month": 1,
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"logicalDate": "1918-06-04",
"month": 6,
"year": 1918
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Page context
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"ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName in full Sara (last) m Gray\nTel. No. Gr 7.4536\n(first)\n(middle)\nIf married, give maiden name\nYear of birth 1886\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nPermanent address % mrs m Snedden 2256202 St- City\n(street)\n(city)\n(county)\n(state)\nProbable for the next address year 63265St NY\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nher m (name) warmright. (relationship) Sister. Bengham Hall (address) Hrg. Canandaigna my\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nVirginnia Day nursed 632 E 5 st. ng.ct\nPublic health\nIndustrial\nPrivate duty\nOther (write in)\nSocial service 18yrs\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 in of the following special services? no.p.g\npostgraduate course or experience any\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 Experience\n4yr\nAnaesthesia\n6 miths\nPublic health nursing writing hurning\n2. Have you taken any courses in a college or university?\nno\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\nA\nCertificate in\ndegree\nPublic Health\nIn what major field was above study?\nTom none infect\nI\nWhat languages, other than English, do you speak?\nAcademic year\n(OVER)\n5-18-43 K,C,"
}