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M
Form 1045
a
Rev. Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
+
Name in full manger (last) (first) (middle) Tel. No. Mr. 2-8%00
Jelicie Due Bruchet
F
Year of birth 1884
co
If married, give maiden name
=
Marital status.
Husband's name
Permanent address 132E 45 new Yust
(single, married, widowed, divorced)
new fand
c
e
(street)
(city)
(county)
(state)
Probable address
for the next year
same
(street)
(city)
(county)
(state)
I
Give or
m. name and Paul address of 9. nearest(relative mauget friend in (hother) United States: Box156 (address) Preeus too n.Cardies
a
(name)
(relationship)
6
Are you employed in nursing at the present time? Yes
No
o
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
F
C
Institutional
5
Public health
+
Industrial
Private
duty in) But Musing Bu
Other (write
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
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
_4
In what major field was above study?
What languages, other than English, you
do speak? None
Academic year
(OVER)
Page data
- Page
- 18
- Source index
- 0
- Type
- photo
- Media ID
- dd301a97ebed535c
- Size
- unknown
Document data
- ID
- 2661882
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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"ocrText": "M\nForm 1045\na\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\n+\nName in full manger (last) (first) (middle) Tel. No. Mr. 2-8%00\nJelicie Due Bruchet\nF\nYear of birth 1884\nco\nIf married, give maiden name\n=\nMarital status.\nHusband's name\nPermanent address 132E 45 new Yust\n(single, married, widowed, divorced)\nnew fand\nc\ne\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\nsame\n(street)\n(city)\n(county)\n(state)\nI\nGive or\nm. name and Paul address of 9. nearest(relative mauget friend in (hother) United States: Box156 (address) Preeus too n.Cardies\na\n(name)\n(relationship)\n6\nAre you employed in nursing at the present time? Yes\nNo\no\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nF\nC\nInstitutional\n5\nPublic health\n+\nIndustrial\nPrivate\nduty in) But Musing Bu\nOther (write\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? One\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\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\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\n_4\nIn what major field was above study?\nWhat languages, other than English, you\ndo speak? None\nAcademic year\n(OVER)"
}