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A 5 - S e Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS NURSING SERVICE JAN 21942 Name in Anteinette Tel. No. Eric.14-10-29 D (last) (first) (middle) 5 If married, give maiden name Year of birth 1879 + 0 Marital status Husband's name (single, married, widowed, divorced) Permanent address Apartade 2625, Mexico D.F. (street) (city) (county) (state) Probable address for the next year (street) (city) (county) (state) Give name and address of nearest relative or friend in United States: Mrs. a M. A.Hortman 4601 Lafaye St.New Orleans, La. (name) (relationship) (address) Are you employed in nursing at the present time? Yes No PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed Institutional Public health Industrial admort nebiald 1553 Private duty Other (write in) Government Service: Army, Regular Navy, Regular Veterans Administration Reserve Resèrve Children's Bureau U.S.P.H. Service U.S. Indian Service MAJOR RESPONSIBILITIES Administration Teaching Private duty of present employment Supervision General Staff Other (specify) How many years did you attend HIGH SCHOOL? One TWO Three Four Graduated Yes No. SINCE GRADUATION FROM YOUR SCHOOL OF NURSING have you ever had- 1. A postgraduate course or experience in any of the following special services? Postgraduate course Experience in hospital in a hospital or public health field (at least 3 months) (at least 6 months) Communicable disease nursing (include Tbc) Psychiatric Nursing Operating room Anaesthesia Public health nursing 2. Have you taken any courses in a college or university? Less than One Two Three Four Bachelor's Master's P.H.D. Certificate in * one year year years years years degree degree degree Public Health I - In what major field was above study? acandemic S What languages, other than English, do you speak? a little German as well spanash + 0 *Academic year (OVER)

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    "ocrText": "A\n5\n-\nS\ne\nForm 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nJAN 21942\nName in Anteinette\nTel. No.\nEric.14-10-29\nD\n(last)\n(first)\n(middle)\n5\nIf married, give maiden name\nYear of birth 1879\n+\n0\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nPermanent address Apartade 2625, Mexico D.F.\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nMrs. a M. A.Hortman\n4601 Lafaye St.New Orleans, La.\n(name)\n(relationship)\n(address)\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nIndustrial\nadmort nebiald 1553\nPrivate duty\nOther (write in)\nGovernment Service:\nArmy, Regular\nNavy, Regular\nVeterans Administration\nReserve\nResèrve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL? One\nTWO\nThree\nFour\nGraduated\nYes\nNo.\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1.\nA postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n* one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nI\n-\nIn what major field was above study? acandemic\nS\nWhat languages, other than English, do you speak? a little German as well spanash\n+\n0\n*Academic year\n(OVER)"
}