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Confidential
FORM 1219
REV. JAN. 1943
D
Please return
AMERICAN RED CROSS
ed
APPLICATION FOR EMPLOYMENT - NURSING PERSONNEL
I. PERSONAL
Badge (No 66919
Name in full miss (MISS OR MRS.) Sunjay MARRIED, GIVE Holt MAIDEN
(H.D.
(IF NAME ALSO)
Not enrolled
Present address 20 west 36 Kansas Cirly mo Tel. No. we 8793
(STREET)
(CITY)
(STATE)
at
Olathe Kansas Tel. No 192
Permanent address
-
(STREET)
(CITY)
Citizenship yes
Color
Place (STATE) of birth quinten, Oklahoma
Present position Educational Director 03818 $2520.00 but Date of birth 12-7-1898
(TITLE)
(SALARY)
Visiting (ORGANIZATION) Nurse Association
1325 Real (ADDRESS) Eldg
Single
Widowed
Married
Divorced
II. PROFESSIONAL STATUS
States registered missouri I Kansas Current registration missouri
To what professional organizations do you belong? A.NA mo State nurses association.
Rublic Health K.C League nursing N.L n.E.
If not an enrolled Red Cross nurse, have you applied for enrollment?
When?
To whom?
KIID
III. EDUCATION
1. Prior to entering school of nursing:
Name
alachetis
City and State
Dates Diploma-Degree Major
High School
alathe 15
1914-18
yes Dylana inne
Sci
Normal School
..
University
Other
2. School of nursing from) St maxy's (NAME) Hospital Kansas (CITY) City missouri (STATE)
which you graduated)
Length of course
5 years
3 years
(Specify other)
Date completed may 1922
3. Undergraduate affiliations:
Hospital or Organization
City and State
Clinical Specialty No. Months
(1)
(2)
)
(3)
4. Postgraduate clinical courses:
(Do not include academic work or employment.)
Hospital or Organization
City and State Clinical Specialty
Dates
(1)
(2)
6 ,
(3)
5. Academic study since graduation from school of nursing:
1
College or University
City and State
Academic years
No. Points
(1)
(2) (3) University amminssota minnesigotis min
1933-1943
B.S Degree
P.I nursing" is
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"ocrText": "I\n0\n-\n+\nConfidential\nFORM 1219\nREV. JAN. 1943\nD\nPlease return\nAMERICAN RED CROSS\ned\nAPPLICATION FOR EMPLOYMENT - NURSING PERSONNEL\nI. PERSONAL\nBadge (No 66919\nName in full miss (MISS OR MRS.) Sunjay MARRIED, GIVE Holt MAIDEN\n(H.D.\n(IF NAME ALSO)\nNot enrolled\nPresent address 20 west 36 Kansas Cirly mo Tel. No. we 8793\n(STREET)\n(CITY)\n(STATE)\nat\nOlathe Kansas Tel. No 192\nPermanent address\n-\n(STREET)\n(CITY)\nCitizenship yes\nColor\nPlace (STATE) of birth quinten, Oklahoma\nPresent position Educational Director 03818 $2520.00 but Date of birth 12-7-1898\n(TITLE)\n(SALARY)\nVisiting (ORGANIZATION) Nurse Association\n1325 Real (ADDRESS) Eldg\nSingle\nWidowed\nMarried\nDivorced\nII. PROFESSIONAL STATUS\nStates registered missouri I Kansas Current registration missouri\nTo what professional organizations do you belong? A.NA mo State nurses association.\nRublic Health K.C League nursing N.L n.E.\nIf not an enrolled Red Cross nurse, have you applied for enrollment?\nWhen?\nTo whom?\nKIID\nIII. EDUCATION\n1. Prior to entering school of nursing:\nName\nalachetis\nCity and State\nDates Diploma-Degree Major\nHigh School\nalathe 15\n1914-18\nyes Dylana inne\nSci\nNormal School\n..\nUniversity\nOther\n2. School of nursing from) St maxy's (NAME) Hospital Kansas (CITY) City missouri (STATE)\nwhich you graduated)\nLength of course\n5 years\n3 years\n(Specify other)\nDate completed may 1922\n3. Undergraduate affiliations:\nHospital or Organization\nCity and State\nClinical Specialty No. Months\n(1)\n(2)\n)\n(3)\n4. Postgraduate clinical courses:\n(Do not include academic work or employment.)\nHospital or Organization\nCity and State Clinical Specialty\nDates\n(1)\n(2)\n6 ,\n(3)\n5. Academic study since graduation from school of nursing:\n1\nCollege or University\nCity and State\nAcademic years\nNo. Points\n(1)\n(2) (3) University amminssota minnesigotis min\n1933-1943\nB.S Degree\nP.I nursing\" is"
}