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Malamay as be-
loop RED leh CROSS rol
Much
FORM 1045
REV. OCT. 1943
AMERICAN
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
Red Cross
If you have changed your last name
Badge number 63, 553
since contacting us, please check here.
Name in full
Kersey
Ethel
Tel. No.
(last)
(first)
(middle)
If married, give maiden name
Date of birth 10/21-1898
Marital status
Single
Husband's name
Permanent address 21 1/2 (street) West High (city) Street, ElizabethtowN, (county) Lancastar Co- Pennsylvania
(single, married, widowed, divorced)
(state)
Present address 506 MonRoe
Allegan
(street)
(city)
AllegaN
(country)
Michigan
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
MRS
Beda
(name)
May Lewis Kersey (MRS (address) George R. Kersey Elizabethtown 21 12West Highst Mother
Va (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
PH.N. with allegan County Health Dept ias cooperation with W.K Kellogg Foundation
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 wit 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? yea
To teach volunteer nurse's aides?
yes
To take a Red Cross emergency assignment? yes
To serve overseas caring for civilians?
yes
Have you ever served with the Red Cross in a disaster? Yes
No
If yes, specify type of disaster
Page data
- Page
- 17
- Source index
- 0
- Type
- photo
- Media ID
- ee61d1862aa50336
- Size
- unknown
Document data
- ID
- 2661748
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "Malamay as be-\nloop RED leh CROSS rol\nMuch\nFORM 1045\nREV. OCT. 1943\nAMERICAN\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nRed Cross\nIf you have changed your last name\nBadge number 63, 553\nsince contacting us, please check here.\nName in full\nKersey\nEthel\nTel. No.\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate of birth 10/21-1898\nMarital status\nSingle\nHusband's name\nPermanent address 21 1/2 (street) West High (city) Street, ElizabethtowN, (county) Lancastar Co- Pennsylvania\n(single, married, widowed, divorced)\n(state)\nPresent address 506 MonRoe\nAllegan\n(street)\n(city)\nAllegaN\n(country)\nMichigan\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\nBeda\n(name)\nMay Lewis Kersey (MRS (address) George R. Kersey Elizabethtown 21 12West Highst Mother\nVa (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\nPH.N. with allegan County Health Dept ias cooperation with W.K Kellogg Foundation\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 wit 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? yea\nTo teach volunteer nurse's aides?\nyes\nTo take a Red Cross emergency assignment? yes\nTo serve overseas caring for civilians?\nyes\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nIf yes, specify type of disaster"
}