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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
41,543
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
TELEPHONE NO.
M
meserall marian Catherine
IF MARRIED, GIVE MAIDEN NAME
HUSBAND'S NAME
as
PERMANENT ADDRESS (Street, city, zone, county, state)
PRESENT city, zone,
Kula saw. Waiakora mani T.H.
62 ADDRESS South (Street, st manasquan county, state) new Jereey *
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
mo Esteela meserall - manasquan n.J
mother
DATE OF BIRTH (Month day, year)
12-10-1898
Single
X
Married
Separated
lidowed
Divorced
a
WHAT LANGUAGES DO YOU SPEAK?
kerman
YES
NO
HIGH SCHOOL GRADUATE
X
+
NAME OF COLLEGE OR
DEGREE OR
5
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
State Teachers College Newark n.J
18 credits mi Public Health
5
e
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
X
ny. PRESENT
NURSES' ASSOCIATION?
X
EMPLOYMENT If not employed,
check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.) TB+
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED Kula San
Daiakoa mani TH
general CITY Hosp. 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 Lining 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
Returning to manland 11/1/45 for 6months
1. Teach home
NO Attend an instructors' training program, 1f of fered. (Funds are available for
YES
NO
YES
nursing classes
training home nursing instructors. See local chapter.)
YES
only in home community
Attend disaster institutes, if
YES
NO
2. Serve in case
NO
of disaster
In other communities
offered, in preparation for service
4. Accept membership on chapter cóm-
YES
NO
5. Assist wi th other chapter
YES
NO
3. Teach nurse's
YES
NO
aide classes
X
mittee 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?
IF UNABLE TO SERVE, GIVE MAJOR REASONS-
DATE
S IGNATURE
9 / 19 / 45
marian C.meserpel
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITRFULNESS
IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTDY TO THE
COMMITTEE NAMED BELOW.
e
ATTENTION
Fill in committee name and address before sending questionnaire to nurse)
from
SECRETARY
NURSE RECRUITMENT
COMMITTEE
Hawaii
PoBoy 3948 Henelular
78504M
FORM 1045 Rev. July 1945
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"ocrText": "3\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n41,543\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nM\nmeserall marian Catherine\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nas\nPERMANENT ADDRESS (Street, city, zone, county, state)\nPRESENT city, zone,\nKula saw. Waiakora mani T.H.\n62 ADDRESS South (Street, st manasquan county, state) new Jereey *\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nmo Esteela meserall - manasquan n.J\nmother\nDATE OF BIRTH (Month day, year)\n12-10-1898\nSingle\nX\nMarried\nSeparated\nlidowed\nDivorced\na\nWHAT LANGUAGES DO YOU SPEAK?\nkerman\nYES\nNO\nHIGH SCHOOL GRADUATE\nX\n+\nNAME OF COLLEGE OR\nDEGREE OR\n5\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nState Teachers College Newark n.J\n18 credits mi Public Health\n5\ne\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nX\nny. PRESENT\nNURSES' ASSOCIATION?\nX\nEMPLOYMENT If not employed,\ncheck\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.) TB+\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED Kula San\nDaiakoa mani TH\ngeneral CITY Hosp. STATE\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 Lining 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\nReturning to manland 11/1/45 for 6months\n1. Teach home\nNO Attend an instructors' training program, 1f of fered. (Funds are available for\nYES\nNO\nYES\nnursing classes\ntraining home nursing instructors. See local chapter.)\nYES\nonly in home community\nAttend disaster institutes, if\nYES\nNO\n2. Serve in case\nNO\nof disaster\nIn other communities\noffered, in preparation for service\n4. Accept membership on chapter cóm-\nYES\nNO\n5. Assist wi th other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\naide classes\nX\nmittee 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?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS-\nDATE\nS IGNATURE\n9 / 19 / 45\nmarian C.meserpel\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITRFULNESS\nIN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTDY TO THE\nCOMMITTEE NAMED BELOW.\ne\nATTENTION\nFill in committee name and address before sending questionnaire to nurse)\nfrom\nSECRETARY\nNURSE RECRUITMENT\nCOMMITTEE\nHawaii\nPoBoy 3948 Henelular\n78504M\nFORM 1045 Rev. July 1945"
}