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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)

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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)"
}