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Backus, Marion Azella

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RED CROSS BADGE NUMBER AMERICAN RED CROSS 19024 Mari M AUG 30 1948 NURSING SERVICES MILITARY SERIAL NUMBER 1. ANNUAL QUESTIONNAIRE - 1945 CHECK IF YOUR LAST NAME HAS CHANGED NAME (Last, first, middle) TELEPHONE NO. Backos marion Azella IF MARRIED, GIVE MAIDEN NAME HUSBANDS NAME Calfax 23857 PERMANENT ADDRESS (Street, city, zone, county, state) 212W Street minncapolis@mming PRESENT ADDRESS (Street, city, zone, county, state) same NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES RELATIONSHIP miss Sarah Os born $ 1623W 32ndst Mpls Fraind DATE OF BIRTH (Month, day, year) Single Married Separated Widowed D1 vorced (0c1 - 4 - 1891 WHAT LANGUAGES DO YOU SPEAK? YES NO HIGH SCHOOL GRADUATE NAME OF COLLEGE OR DEGREE OR UNIVERSITY ATTENDED Macalsslei- LOCATION St Paul miniforusive DATES 1940 DIPLOMA MAJOR ARE YOU CURRENTLY YES NO REGISTERED IN (State) ARE YOU CURRENTLY A MEMBER OF THE AMERICAN YES NO REGISTERED? X minn NURSES' ASSOCIATION? X PRESENT EMPLOYMENT If not employed, check POSITION TITLE (H.N., P.D., inst., staff nurse, etc.) SERVICE (Medicine, surgery, etc.) NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED CITY STATE N HEALTH IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY good. VOLUNTEER SERVICE The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call to participate in a Red Cross chapter program. Please check the "Yes" box only if you are billing and able to serve if called on wi thin the next 12 months. NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS < 1. Teach home YES NO Attend an instructors' training program, if offered. (Fünds are available for YES NO nursing classes training home nursing instructors. See local chapter.) 2. Serve in case YES NO only in home community Attend disaster institutes, if YES NO of disaster In other communities offered, in preparation for service 3. Teach nurse's YES NO 4. Accept membership on chapter com- YES NO 5. Assist with other chapter YES NO aide classes mittee should services be needed programs, as needed If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that YES NO you will be able to serve at some time in the future? IF UNABLE TO SERVE, GIVE MAJOR REASONS- DATE 8-26-45- SIGNATURE Marin aBackus) YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHPOLNESS IN KEEPING US INFORM6D OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY COMMITTES NAMED BELOW. ATTENTION Fill in committee name and address before sending questionnaire to nurse. to SECRETARY HENNEPIN COUNTY NURSE RECRUITMENT COMMITTRE NURSE RECRUITMENT 9124145 - 325 Groveland Avenue, Minneapolis 4, Minnesota COMMITTEE 78504M FORM 1045 Rev. July 1945

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Page
13
Source index
0
Type
photo
Media ID
91cb7e0d90078f4d
Size
unknown

Document data

ID
2661064
Core
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Type
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Context sent to Scholar

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    "ocrText": "RED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n19024\nMari\nM\nAUG 30 1948\nNURSING SERVICES\nMILITARY SERIAL NUMBER\n1.\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nBackos marion\nAzella\nIF MARRIED, GIVE MAIDEN NAME\nHUSBANDS NAME\nCalfax 23857\nPERMANENT ADDRESS (Street, city, zone, county, state)\n212W Street minncapolis@mming\nPRESENT ADDRESS (Street, city, zone, county, state)\nsame\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nmiss Sarah Os born $ 1623W 32ndst Mpls\nFraind\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated\nWidowed\nD1 vorced\n(0c1 - 4 - 1891\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY\nATTENDED Macalsslei- LOCATION St Paul miniforusive DATES 1940 DIPLOMA\nMAJOR\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nX\nminn\nNURSES' ASSOCIATION?\nX\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nN\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\ngood.\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are billing and able to\nserve if called on wi thin the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n<\n1. Teach home\nYES\nNO\nAttend an instructors' training program, if offered. (Fünds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof disaster\nIn other communities\noffered, in preparation for service\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\naide classes\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS-\nDATE 8-26-45-\nSIGNATURE\nMarin aBackus)\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHPOLNESS IN\nKEEPING US INFORM6D OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY\nCOMMITTES NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nto\nSECRETARY\nHENNEPIN COUNTY NURSE RECRUITMENT COMMITTRE\nNURSE RECRUITMENT\n9124145 -\n325 Groveland Avenue, Minneapolis 4, Minnesota\nCOMMITTEE\n78504M\nFORM 1045 Rev. July 1945"
}