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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
HD2224
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
TELEPHONE NO.
IF MARRIED, GIVE MAIDEN NAME
Schlesinger, Stefanie
Path Anbay 4. 3700
HUSBAND'S NAME
PERMANENT ADDRESS (Street, city, zone, county, state)
129 Prospect PI.
PRESENT ADDRESS (Street, city, zone, county, state)
So Canange, h g.
Perth awhay General Hospital
Perth Authay 2.
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
Mr. L.F, Bird
(Friend) 129 Purpect PI. So Grauge n
friend
DATE OF BIRTH (Month, day, year)
Feb 2 - 1898
Single
Married
Separated
Widowed
Divorced
WHAT LANGUAGES DO YOU SPEAK?
YES
NO
German
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
Setm New College
Awark, h J.
may 1943
B.
numing Ed.
Surm Have College
Newark W. working on Masters Degree in Guidance
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
n.g
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
Director of nursing Principal School of nursing
General
CITY
STATE
Perth Ambay General Hospital,
Perth Ambay
n.f.
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 WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
Perth ambay Chapter Hohart Beda.
Perth ambay w.
1. Teach home
YES
NO
Attend an instructors' training program, 11 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 com-
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.
Program in Hospital too Resoy. due to shortage of numes
DATE
SIGNATURE
aug 15.1945
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHFULNESS IN
Stefamic Schunger
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
AMERICAN RED CROSS
NURSE RECRUITMENT
PERTH AMBOY . CARTERET CHAPTER
COMMITTEE
PERTH AMBOY, N. J.
78504M
FORM 1045 Rev. July 1945
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Document data
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- Core
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- Type
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"ocrText": "RED CROSS BADGE NUMBER\nAMERICAN RED CROSS\nHD2224\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nIF MARRIED, GIVE MAIDEN NAME\nSchlesinger, Stefanie\nPath Anbay 4. 3700\nHUSBAND'S NAME\nPERMANENT ADDRESS (Street, city, zone, county, state)\n129 Prospect PI.\nPRESENT ADDRESS (Street, city, zone, county, state)\nSo Canange, h g.\nPerth awhay General Hospital\nPerth Authay 2.\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nMr. L.F, Bird\n(Friend) 129 Purpect PI. So Grauge n\nfriend\nDATE OF BIRTH (Month, day, year)\nFeb 2 - 1898\nSingle\nMarried\nSeparated\nWidowed\nDivorced\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\nGerman\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nSetm New College\nAwark, h J.\nmay 1943\nB.\nnuming Ed.\nSurm Have College\nNewark W. working on Masters Degree in Guidance\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nn.g\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\nDirector of nursing Principal School of nursing\nGeneral\nCITY\nSTATE\nPerth Ambay General Hospital,\nPerth Ambay\nn.f.\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 WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nPerth ambay Chapter Hohart Beda.\nPerth ambay w.\n1. Teach home\nYES\nNO\nAttend an instructors' training program, 11 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 com-\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.\nProgram in Hospital too Resoy. due to shortage of numes\nDATE\nSIGNATURE\naug 15.1945\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHFULNESS IN\nStefamic Schunger\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nAMERICAN RED CROSS\nNURSE RECRUITMENT\nPERTH AMBOY . CARTERET CHAPTER\nCOMMITTEE\nPERTH AMBOY, N. J.\n78504M\nFORM 1045 Rev. July 1945"
}