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I
K
C
L
FORM 1045
REV. OCT.
AMERICAN RED CROSS
e
S
NURSING SERVICE
a
d
ANNUAL QUESTIONNAIRE-194
a
oM
mo not
Red Cross
15445
If you have changed your last name
Badge number
since contacting us, please check here.
F
Name in full
Hickcox
Vevda
Fern
(last)
Tel. No. Regent 4-6000
e
(first)
(middle)
T
If married, give maiden name
Date of birth Dec 20 1892
5
Marital status
single
Husband's name
(single, married, widowed, divorced)
Permanent address 1320 York Ave New Youk 21 New York
NewYork
(street)
(city)
(county)
(state)
Present address
same as above
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
Mrs Jules Klosterman
40 Maplewood Ave Bogota, N.J.
sister
(name)
(address)
(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
Head of Obstervical Y Gynecological Nursing Service - Instruction
Cornell University - New york Hospital School of Nursing New York 21, NewYork
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:
A P.A.
To teach Red Cross Home Nursing classes?
5
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
4
vil.
To serve overseas caring for civilians?
4
Have you ever served with the Red Cross in a disaster? Yes
No
5
If yes, specify type of disaster
Page data
- Page
- 12
- Source index
- 0
- Type
- photo
- Media ID
- 8020c9f092234de4
- Size
- unknown
Document data
- ID
- 2661638
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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"ocrText": "I\nK\nC\nL\nFORM 1045\nREV. OCT.\nAMERICAN RED CROSS\ne\nS\nNURSING SERVICE\na\nd\nANNUAL QUESTIONNAIRE-194\na\noM\nmo not\nRed Cross\n15445\nIf you have changed your last name\nBadge number\nsince contacting us, please check here.\nF\nName in full\nHickcox\nVevda\nFern\n(last)\nTel. No. Regent 4-6000\ne\n(first)\n(middle)\nT\nIf married, give maiden name\nDate of birth Dec 20 1892\n5\nMarital status\nsingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 1320 York Ave New Youk 21 New York\nNewYork\n(street)\n(city)\n(county)\n(state)\nPresent address\nsame as above\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\nMrs Jules Klosterman\n40 Maplewood Ave Bogota, N.J.\nsister\n(name)\n(address)\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\nHead of Obstervical Y Gynecological Nursing Service - Instruction\nCornell University - New york Hospital School of Nursing New York 21, NewYork\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. She\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:\nA P.A.\nTo teach Red Cross Home Nursing classes?\n5\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\n4\nvil.\nTo serve overseas caring for civilians?\n4\nHave you ever served with the Red Cross in a disaster? Yes\nNo\n5\nIf yes, specify type of disaster"
}