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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.
Page data
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- 13
- Source index
- 0
- Type
- photo
- Media ID
- 359aa15069f40f8d
- Size
- unknown
Document data
- ID
- 2662441
- Core
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- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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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."
}