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FORM 1045 REV. JAN 1941 AMERICAN RED CROSS 12 NATIONAL HEADQUARTERS WASHINGTON, D.C. Name in full WATerlally Birth Christiana Year of Birth 1881 (SURNAME) (FIRST) (MIDDLE) Husband's name Permanent address 10 Sheridan SUILARE NEWYORK - NEWYORK. (STREET) (CITY) ACOUNTY) (STATE) Probable address samesabove for the next year (STREET) (CITY) (COUNTY) (STATE) Telephone number Chelseil 2-5874 (EXCHANGE) (NO.) Give name and address of nearest relative or friend in United States: Mrs. John GuyWoodward- (RELATIONSHIP) Sister_ 615 (ADDRESS) st. Illinois Joliet. (NAME) PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed Institutional Public Health Metropolitan Life Insurance Company Private duty 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 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 food. Badge No. 6620. Current date February 11 1941 MANHATTAR Name of Committee 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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2662441
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    "ocrText": "FORM 1045\nREV. JAN 1941\nAMERICAN RED CROSS\n12\nNATIONAL HEADQUARTERS\nWASHINGTON, D.C.\nName in full WATerlally Birth Christiana\nYear of Birth 1881\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent\naddress 10 Sheridan SUILARE NEWYORK - NEWYORK.\n(STREET)\n(CITY)\nACOUNTY)\n(STATE)\nProbable address\nsamesabove\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number Chelseil 2-5874\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nMrs. John GuyWoodward- (RELATIONSHIP) Sister_ 615 (ADDRESS) st. Illinois Joliet.\n(NAME)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nPublic Health\nMetropolitan Life Insurance Company\nPrivate duty\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\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\n(WRITE 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\n-\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nPresent physical condition\nfood.\nBadge No. 6620.\nCurrent date February 11 1941\nMANHATTAR\nName of Committee\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."
}