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Confidential
FORM 1219
REV. JAN. 1943
Please return
AMERICAN RED CROSS
APPLICATION FOR EMPLOYMENT - NURSING PERSONNEL
I. PERSONAL
Badge (No 58962
Name in full Miss (MISS OR andrey MRS.) marie (IF MARRIED. GIVE Jate MAIDEN NAME
(H.D
ALSO)
Not enrolled
Present address 1655-34 th St n. W, D.C. Tel. No me 2297
(CITY)
(STATE)
Permanent address (STREET) 1655-34 th st.n.w. D.C. Tel. No mi 2297
(STREET)
(CITY)
(STATE)
Citizenship American Color white Place
of birth
Present position Private (TITLE) Duty 9.00 (SALARY) 12 "
6.00 per day 8hr.
Date of birth Sept. , 1912
Emergency (ORGANTZATION Hospital, 17th n.y. (ADDRESS) ave, D.C
Single
Widowed
Married
Divorced
II. PROFESSIONAL STATUS
States registered D. C .
D. C
Current registration
To what professional organizations do you belong? graduate Junes association
of D.d - anemean nuises association for enrollment?
not an enrolled Red Cross nurse, have you applied
When?
To whom?
III. EDUCATION
1. Prior to entering school of nursing:
Name
City and State
Dates
Diploma-Degree
Major
High School Business Hig hSchool Wach D.C. 1926-1930
Normal School
University
Other
2.
School which of you nursing graduated) from) Emergency (NAME) Hospital (CITY) Washington (STATE) D.C.
Length of course
5 years 3 years
(Specify other) Date completed 1933
3. Undergraduate affiliations:
Hospital or Organization
City and State
Clinical Specialty No. Months
-
(1) Sibley memorial
(2 Children's Hospital
Unchanged
D.C.
Obstelreco
3
Pediatrics 3
"
"
(3) I.V.n.S
Washington, D.C. Public Health
2
4. Postgraduate clinical courses:
(Do not include academic work or employment.)
Hospital or Organization
City and State
Clinical Specialty
Dates
(1)
(2)
(3)
5. Academic study since graduation from school of nursing:
College or University
City and State
Academic years No. Points
(1)
(2)
(3)
Page data
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- Source index
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- Type
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- Core
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- Type
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"ocrText": "Confidential\nFORM 1219\nREV. JAN. 1943\nPlease return\nAMERICAN RED CROSS\nAPPLICATION FOR EMPLOYMENT - NURSING PERSONNEL\nI. PERSONAL\nBadge (No 58962\nName in full Miss (MISS OR andrey MRS.) marie (IF MARRIED. GIVE Jate MAIDEN NAME\n(H.D\nALSO)\nNot enrolled\nPresent address 1655-34 th St n. W, D.C. Tel. No me 2297\n(CITY)\n(STATE)\nPermanent address (STREET) 1655-34 th st.n.w. D.C. Tel. No mi 2297\n(STREET)\n(CITY)\n(STATE)\nCitizenship American Color white Place\nof birth\nPresent position Private (TITLE) Duty 9.00 (SALARY) 12 \"\n6.00 per day 8hr.\nDate of birth Sept. , 1912\nEmergency (ORGANTZATION Hospital, 17th n.y. (ADDRESS) ave, D.C\nSingle\nWidowed\nMarried\nDivorced\nII. PROFESSIONAL STATUS\nStates registered D. C .\nD. C\nCurrent registration\nTo what professional organizations do you belong? graduate Junes association\nof D.d - anemean nuises association for enrollment?\nnot an enrolled Red Cross nurse, have you applied\nWhen?\nTo whom?\nIII. EDUCATION\n1. Prior to entering school of nursing:\nName\nCity and State\nDates\nDiploma-Degree\nMajor\nHigh School Business Hig hSchool Wach D.C. 1926-1930\nNormal School\nUniversity\nOther\n2.\nSchool which of you nursing graduated) from) Emergency (NAME) Hospital (CITY) Washington (STATE) D.C.\nLength of course\n5 years 3 years\n(Specify other) Date completed 1933\n3. Undergraduate affiliations:\nHospital or Organization\nCity and State\nClinical Specialty No. Months\n-\n(1) Sibley memorial\n(2 Children's Hospital\nUnchanged\nD.C.\nObstelreco\n3\nPediatrics 3\n\"\n\"\n(3) I.V.n.S\nWashington, D.C. Public Health\n2\n4. Postgraduate clinical courses:\n(Do not include academic work or employment.)\nHospital or Organization\nCity and State\nClinical Specialty\nDates\n(1)\n(2)\n(3)\n5. Academic study since graduation from school of nursing:\nCollege or University\nCity and State\nAcademic years No. Points\n(1)\n(2)\n(3)"
}