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Form 1045
Rev Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
Johnson,
Marie L.
Request. dest
Name in full
Gramercy 5-2476
Tel. No
(last)
(first)
(middle)
If married, give maiden name
Year of birth 1894
Marital status
Single
Husband's name
-
(single, married, widowed, divorced)
235 East 22 St. New York, N. Y.
Permanent address
(street)
(city)
(county)
Probable address
same
(state)
for the next year
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
Mr. Ralph Johnson, Coon Valley, Wisconsin
(brother)
(name)
(relationship)
(address)
Are you employed in nursing at the present time? Yes
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
Institutional
Public health
Metropolitan Life Insurance Compamy
Industrial
Private duty
Other (write in)
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 postgraduate course or experience in any of the following special services?
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
Anaesthesia
Public health nursing
-yes
2. Have you taken any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
P.H.D.
Certificate in
one year
year
years
years
years
degree
degree
degree
Public Health
2
In what major field was above study?
Public Health Nursing
2
C
What languages, other than English, do you speak?
Norwegian
** Academic year
(OVER)
N
Page data
- Page
- 13
- Source index
- 0
- Type
- photo
- Media ID
- 99a5ac55e67429f8
- Size
- unknown
Document data
- ID
- 2661712
- Core
- doc
- Type
- document
DTO data
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"ocrText": "Form 1045\nRev Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nJohnson,\nMarie L.\nRequest. dest\nName in full\nGramercy 5-2476\nTel. No\n(last)\n(first)\n(middle)\nIf married, give maiden name\nYear of birth 1894\nMarital status\nSingle\nHusband's name\n-\n(single, married, widowed, divorced)\n235 East 22 St. New York, N. Y.\nPermanent address\n(street)\n(city)\n(county)\nProbable address\nsame\n(state)\nfor the next year\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nMr. Ralph Johnson, Coon Valley, Wisconsin\n(brother)\n(name)\n(relationship)\n(address)\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nMetropolitan Life Insurance Compamy\nIndustrial\nPrivate duty\nOther (write in)\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?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1. A postgraduate course or experience in any of the following special services?\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\nAnaesthesia\nPublic health nursing\n-yes\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\none year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\n2\nIn what major field was above study?\nPublic Health Nursing\n2\nC\nWhat languages, other than English, do you speak?\nNorwegian\n** Academic year\n(OVER)\nN"
}