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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)

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18
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0
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2661882
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        "logicalDate": "1945-08-25",
        "month": 8,
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Page context
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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)"
}