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FORM 1045
AMERICAN RED CROSS
REV. DEC. 1939
e
NATIONAL HEADQUARTERS
a
WASHINGTON, D. c.
d
Name in full
Hickcox
Verda
Fern
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
Permanent address
1320 York Ave.
New York
New York
New York
(STREET)
(CITY)
(COUNTY)
(STATE)
Probable address
1320 York Ave.
New York
for the next year
New York
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
Regent
4 .6000
(EXCHANGE)
(NO.)
Nearest relative or friend in United States, through whom you may be communicated with in
an emergency:
Mrs Jule Klosterman
sister
(NAME)
(RELATIONSHIP)
40 Maplewood Ave.
Bogota
New
(STREET)
(CITY)
(STATE)
PRESENT WORK (check below)
Name of agency or institution with which employed
V
Institutional
Public Health
Private duty
Other (write in)
Government Service: Army
U.S.P.H.Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
IF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other (write in)
Would you respond to an emergency call in event of local or national emergency, such as
epidemic, flood, war, etc. It would be difficult to be released yery promptly.
(Granted of course that you could be released from present employment)
Present physical condition
Satisfactory,
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
No.
Are you a member of the American Nurses' Association?
Yes.
If not, why have you allowed your membership to lapse?
Badge No. 14445.
Current date March 15 1940
Name of Committee
MANHATTAN
5
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enrollment will be removed from our active files.
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Document data
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- Core
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"ocrText": "I\n2\nFORM 1045\nAMERICAN RED CROSS\nREV. DEC. 1939\ne\nNATIONAL HEADQUARTERS\na\nWASHINGTON, D. c.\nd\nName in full\nHickcox\nVerda\nFern\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent address\n1320 York Ave.\nNew York\nNew York\nNew York\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address\n1320 York Ave.\nNew York\nfor the next year\nNew York\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\nRegent\n4 .6000\n(EXCHANGE)\n(NO.)\nNearest relative or friend in United States, through whom you may be communicated with in\nan emergency:\nMrs Jule Klosterman\nsister\n(NAME)\n(RELATIONSHIP)\n40 Maplewood Ave.\nBogota\nNew\n(STREET)\n(CITY)\n(STATE)\nPRESENT WORK (check below)\nName of agency or institution with which employed\nV\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H.Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nIF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nWould you respond to an emergency call in event of local or national emergency, such as\nepidemic, flood, war, etc. It would be difficult to be released yery promptly.\n(Granted of course that you could be released from present employment)\nPresent physical condition\nSatisfactory,\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nNo.\nAre you a member of the American Nurses' Association?\nYes.\nIf not, why have you allowed your membership to lapse?\nBadge No. 14445.\nCurrent date March 15 1940\nName of Committee\nMANHATTAN\n5\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enrollment will be removed from our active files."
}