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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
112721
NURSING SERVICES
MILITARY SERIAL NUMBER
I
ANNUAL QUESTIONNAIRE - 1945
CHECK'I IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
TELEPHONE NO.
nimmer Helen Miniami
908
IF MARRIED, GIVE MAIDEN NAME
HUSBAND S NAME
PERMANENT (Street, city, zone, county, state)
PRESENT
ADDRESS ADDRESS (Street, city, zone, county, state) manining,
outh Carolina
Purnere Hospital Purnene may J 9.
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITEDUSTAT
RELATIONSHIP
Mrs (Month, day, Marie year) minner manning
C
mother
DATE OF BIRTH
subsent
I
Singl
Marriled
Separs ed
Widowed
D1 vorced
WHAT
LANGUAGES June DO YOU 11, SPEAK? 190
YES
NO
american
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
stygeorgha Acgdemy, Sunter S.C
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
SC+Okla
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
Turnere Hup
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 willing and able to
serve if called on within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN AWHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
1. Teach home
Hawaii YES NO Chapter
Attend an instructors' training program, if offered. (Funds are available for
YES
NO
nursing classes
training home nursing instructors. See local chapter.)
2. Serve in case
YES
NO
only in home community
Attend disaster institutes, if
YES
NO
of disaster
In other communities
offered, in preparation for service
3. Teach nurse's
YES
NO
4. Accept membership on chapter cóm-
YES
NO
5. Assist with other chapter
YES
NO
aide classes
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 -
2
DATE 10/20/45
IGNATURE
YOUR VALUE AS 4 RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFOLNESS IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
NURSE RECRUITMENT
COMMITTEE
Leavaii
PaBey 3948 Hendulus
Alice TO THE
78504M
FORM 1045 Rev. July 1945
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"ocrText": "N\nn\nme\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n112721\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nI\nANNUAL QUESTIONNAIRE - 1945\nCHECK'I IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nnimmer Helen Miniami\n908\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND S NAME\nPERMANENT (Street, city, zone, county, state)\nPRESENT\nADDRESS ADDRESS (Street, city, zone, county, state) manining,\nouth Carolina\nPurnere Hospital Purnene may J 9.\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITEDUSTAT\nRELATIONSHIP\nMrs (Month, day, Marie year) minner manning\nC\nmother\nDATE OF BIRTH\nsubsent\nI\nSingl\nMarriled\nSepars ed\nWidowed\nD1 vorced\nWHAT\nLANGUAGES June DO YOU 11, SPEAK? 190\nYES\nNO\namerican\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nstygeorgha Acgdemy, Sunter S.C\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nSC+Okla\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\nTurnere Hup\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 willing and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN AWHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n1. Teach home\nHawaii YES NO Chapter\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof disaster\nIn other communities\noffered, in preparation for service\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter cóm-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\naide classes\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 -\n2\nDATE 10/20/45\nIGNATURE\nYOUR VALUE AS 4 RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFOLNESS IN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nNURSE RECRUITMENT\nCOMMITTEE\nLeavaii\nPaBey 3948 Hendulus\nAlice TO THE\n78504M\nFORM 1045 Rev. July 1945"
}