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FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
Red Cross
Badge number 3882038010
If you have changed your last name
since contacting us, please check here.
a
Name in full Harvard haverna
7
Tel. No. Hem-0314R
L
(last)
(first)
(middle)
If married, give maiden name
Date of birth Feb. 19,1894
er
a
Marital status
X
Husband's name
5
(single, married, widowed, divorçed)
Permanent address 204 church St . Dublin
Laurens
(street)
(city)
(county)
Georgia
a
Present address apt B.10. (street) 1355 Ptree st A+lAnta Fulton
(state)
(city)
Ga
(county)
(state)
F
Notify national headquarters immediately if you change your address.
S
Mrs Alice H. Brinson
Give name and address of nearest relative or friend in the United States:
(name)
204 Churchst (address) Hublin qa
sister
(relationship)
Are you employed in nursing at the present time Yes
No
If employed, check the type of work you are doing and fill in below the title of your position and the name
and address of the agency or institution:
Institutional
Public Health
Industrial
Private Duty
Other
If not employed, what type of nursing would you prefer to render?
IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND
ANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX
AVAILABILITY FOR SERVICE WITH THE ARMED FORCES
Requirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45.
She
may be single or married, but if married she must have no dependents under 14 years of age.
If eligible and not already in service with the armed forces, are you:
Immediately available?
Available in the near future?
(specify date)
Not available, for the following reason ?
(specify)
Do you have any dependents under 14 years of age? Yes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes?
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
W
To serve overseas caring for civilians
If yes, you specify type of disaster merses Flood 1931 Cyclone. No Cochran Ga- 1928
Have ever served with the Red Cross in a disaster? Yes
Page data
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- Source index
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Document data
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- Core
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- Type
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"ocrText": "I\nar\na\nL\na\n1\nD\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nRed Cross\nBadge number 3882038010\nIf you have changed your last name\nsince contacting us, please check here.\na\nName in full Harvard haverna\n7\nTel. No. Hem-0314R\nL\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate of birth Feb. 19,1894\ner\na\nMarital status\nX\nHusband's name\n5\n(single, married, widowed, divorçed)\nPermanent address 204 church St . Dublin\nLaurens\n(street)\n(city)\n(county)\nGeorgia\na\nPresent address apt B.10. (street) 1355 Ptree st A+lAnta Fulton\n(state)\n(city)\nGa\n(county)\n(state)\nF\nNotify national headquarters immediately if you change your address.\nS\nMrs Alice H. Brinson\nGive name and address of nearest relative or friend in the United States:\n(name)\n204 Churchst (address) Hublin qa\nsister\n(relationship)\nAre you employed in nursing at the present time Yes\nNo\nIf employed, check the type of work you are doing and fill in below the title of your position and the name\nand address of the agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nIf not employed, what type of nursing would you prefer to render?\nIT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND\nANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX\nAVAILABILITY FOR SERVICE WITH THE ARMED FORCES\nRequirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45.\nShe\nmay be single or married, but if married she must have no dependents under 14 years of age.\nIf eligible and not already in service with the armed forces, are you:\nImmediately available?\nAvailable in the near future?\n(specify date)\nNot available, for the following reason ?\n(specify)\nDo you have any dependents under 14 years of age? Yes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes?\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\nW\nTo serve overseas caring for civilians\nIf yes, you specify type of disaster merses Flood 1931 Cyclone. No Cochran Ga- 1928\nHave ever served with the Red Cross in a disaster? Yes"
}