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M
e.e.
ar
the
Received 8.29.45
+i
RED CROSS BADGE NUMBER
AMERICAN RED CROSS
33385 cho.te Dever
las
in,
27
NURSING SERVICES
MILITARY SERIAL NUMBER
Me
-
9-4
L
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
E
NAME (Last, first, middle)
TELEPHONE NO.
Martin, Elizabeth
-
2
IF MARRIED, GIVE MAIDEN NAME
HUSBAND'S NAME
Leger
Burns Martin
a
PERMANENT ADDRESS (Street, city, zone, county, state)
c/o Leger gilboa N.Y.
5
PRESENT ADDRESS (Street, city, zone, county, state)
See letter
Temporary - 132 E 45 St; N Y C to dim.
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
9-6-45
DATE OF BIRTH (Month, day, year)
Brother John Leger, gilbop N Y.
Brother
Single
Married
Separated
Widowed
Divorced
8.22.1897
WHAT LANGUAGES DO YOU SPEAK?
YES
NO
german
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
3
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
Deg.
Child Col c
Teachers College, Columbia U N.4. C.
1933
B.S. Teaching H.V. +
S
11
"
age M.A. Supv P.H.I
K
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
N.Y.
NURSES' ASSOCIATION?
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
CITY
STATE
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
good
VOLUNTEER SERVICE
The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call
to participate in a Red Cross chapter program. Please check the "Yes" box only if you are wi ling and able to
serve if called on within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
YES
Attend an instructors' training program, if offered. (Funds are available for
YES
NO
1. Teach home
NO
nursing classes
training home nursing instructors. See local chapter.)
2. Serve in case
YES
NO
only in home community
X
Attend disaster institutes, if
YES
NO
of disaster
x
In other communities
offered, in preparation for service
4. Accept membership on chapter cóm-
YES
NO
5. Assist with other chapter
YES
NO
3. Teach nurse's
YES
NO
aide classes
nittee should services be needed
programs, as needed
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you will be able to serve at some time in the future? posi At present of condidate for full- time
X
IF
UNABLE TO SERVE, GIVE MAJOR REASONS- No settled location at present. mrs
assigns alec staff todate
DATE
S IGNATURE
10/25/45
8.29.45
\
YOUR VALUE AS A RED cross ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHFOLNESS N
NURSE DEPENDS ON YOUR
Eligareth martin
3
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
3
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questgonnaireeimaursehapter
8
SECRETARY
Sent to National Nursing Service Nurse Recruiting Committee
NURSE RECRUITMENT
due to consettled status
511 North Broad Street
5
COMMITTEE
Deid from nurse
Philadelphia, Pa.
FORM 1045 Rev. July 1945
78504M
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- Type
- photo
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Document data
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- Type
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DTO data
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"ocrText": "Z\nM\ne.e.\nar\nthe\nReceived 8.29.45\n+i\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n33385 cho.te Dever\nlas\nin,\n27\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nMe\n-\n9-4\nL\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nE\nNAME (Last, first, middle)\nTELEPHONE NO.\nMartin, Elizabeth\n-\n2\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nLeger\nBurns Martin\na\nPERMANENT ADDRESS (Street, city, zone, county, state)\nc/o Leger gilboa N.Y.\n5\nPRESENT ADDRESS (Street, city, zone, county, state)\nSee letter\nTemporary - 132 E 45 St; N Y C to dim.\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\n9-6-45\nDATE OF BIRTH (Month, day, year)\nBrother John Leger, gilbop N Y.\nBrother\nSingle\nMarried\nSeparated\nWidowed\nDivorced\n8.22.1897\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\ngerman\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\n3\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nDeg.\nChild Col c\nTeachers College, Columbia U N.4. C.\n1933\nB.S. Teaching H.V. +\nS\n11\n\"\nage M.A. Supv P.H.I\nK\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nN.Y.\nNURSES' ASSOCIATION?\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\ngood\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are wi ling and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nYES\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\n1. Teach home\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nNO\nonly in home community\nX\nAttend disaster institutes, if\nYES\nNO\nof disaster\nx\nIn other communities\noffered, in preparation for service\n4. Accept membership on chapter cóm-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\naide classes\nnittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future? posi At present of condidate for full- time\nX\nIF\nUNABLE TO SERVE, GIVE MAJOR REASONS- No settled location at present. mrs\nassigns alec staff todate\nDATE\nS IGNATURE\n10/25/45\n8.29.45\n\\\nYOUR VALUE AS A RED cross ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHFOLNESS N\nNURSE DEPENDS ON YOUR\nEligareth martin\n3\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\n3\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questgonnaireeimaursehapter\n8\nSECRETARY\nSent to National Nursing Service Nurse Recruiting Committee\nNURSE RECRUITMENT\ndue to consettled status\n511 North Broad Street\n5\nCOMMITTEE\nDeid from nurse\nPhiladelphia, Pa.\nFORM 1045 Rev. July 1945\n78504M"
}