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FORM 1045
REV. JAN 1941
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
Name in full Storey
Mariory
Year of Birth
1898
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
30 Hortense Street
Rochester
Monroe
Permanent address
New York
(STREET)
(CITY)
(COUNTY)
(STATE)
Probable address
"
"
"
"
for the next year
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
Genesee
4774
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
Mrs. J.M. Spinning
Sister
568 Wellington Ave. Rochester, N.Y.
(NAME)
(RELATIONSHIP)
(ADDRESS)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
Visiting Nurse Association
Public Health
X
130 Spring Street
Private duty
Rochester, N.Y.
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
MAJOR RESPONSIBILITIES Adminis-
Super
Teach-
General
Private
Other
of present employment tration
vision
ing
X
Staff
Duty
(specify)
IF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other
WRITE IN>
AVAILABILITY
At the present time would you
Date
accept assignment to the Army? Yes
No
Navy? Yes
No
available
In case of a war emergency would you
accept assignment to the Army? Yes
No
Navy? Yes
No
If not now employed would you
accept nursing work? Full-time? Yes
No
Part-time? Yes
No
In your own community? Yes
No
Elsewhere? Yes
No
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
Present physical condition
Good
Badge No. 41828
Current date Marich 4, 1941
Name of Committee Rochester ny
C
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enrollment will be removed from our active files.
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"ocrText": "FORM 1045\nREV. JAN 1941\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nName in full Storey\nMariory\nYear of Birth\n1898\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\n30 Hortense Street\nRochester\nMonroe\nPermanent address\nNew York\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address\n\"\n\"\n\"\n\"\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\nGenesee\n4774\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nMrs. J.M. Spinning\nSister\n568 Wellington Ave. Rochester, N.Y.\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nVisiting Nurse Association\nPublic Health\nX\n130 Spring Street\nPrivate duty\nRochester, N.Y.\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nMAJOR RESPONSIBILITIES Adminis-\nSuper\nTeach-\nGeneral\nPrivate\nOther\nof present employment tration\nvision\ning\nX\nStaff\nDuty\n(specify)\nIF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther\nWRITE IN>\nAVAILABILITY\nAt the present time would you\nDate\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable\nIn case of a war emergency would you\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\nIf not now employed would you\naccept nursing work? Full-time? Yes\nNo\nPart-time? Yes\nNo\nIn your own community? Yes\nNo\nElsewhere? Yes\nNo\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nPresent physical condition\nGood\nBadge No. 41828\nCurrent date Marich 4, 1941\nName of Committee Rochester ny\nC\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enrollment will be removed from our active files."
}