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February 28, 1941
FORM 1045
REV. JAN 1941
Badge No.
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
Name in full
Year of Birth
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
Permanent address
(STREET)
(CITY)
(COUNTY)
(STATE)
Probable address
for the next year
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
(NAME)
(RELATIONSHIP)
(ADDRESS)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
.
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
MAJOR R ESPONSIBILITIES Adminis-
Super
Teach
General
Private
Other
of present employment tration
vision
ing
Staff
Duty
(specify)
IF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other
(WRITE IN)
AVAILABILITY
At the present time would you
Date
accept assignment to the Army? Yes
No
Navy? Yes
No
available
In case of a war emergency would you
accept assignment to the Army? Yes
No
Navy? Yes
No
If not now employed would you
accept nursing work? Full-time? Yes
No
Part-time? Yes
No
In your own community? Yes
No
Elsewhere? Yes
No
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
Present physical condition
Badge No.
Current date
1941
HEADQUARTERS
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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DTO data
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Context sent to Scholar
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Document source extras
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"ocrText": "February 28, 1941\nFORM 1045\nREV. JAN 1941\nBadge No.\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nName in full\nYear of Birth\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent address\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\n.\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\nMAJOR R ESPONSIBILITIES Adminis-\nSuper\nTeach\nGeneral\nPrivate\nOther\nof present employment tration\nvision\ning\nStaff\nDuty\n(specify)\nIF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther\n(WRITE IN)\nAVAILABILITY\nAt the present time would you\nDate\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable\nIn case of a war emergency would you\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\nIf not now employed would you\naccept nursing work? Full-time? Yes\nNo\nPart-time? Yes\nNo\nIn your own community? Yes\nNo\nElsewhere? Yes\nNo\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nPresent physical condition\nBadge No.\nCurrent date\n1941\nHEADQUARTERS\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."
}