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FORM 1045
REV.OCT.1943
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
seY
101
ox oc
Red Cross
Ite
If you have changed your last name
Badge number
30 281
since contacting us, please check here.
Name in full Beauchamp
linnie
Tel. No. Office: 4-6315
(last)
(first)
(middle)
Res:3-1059
If married, give maiden name
-
Date of birth April 23, 1892
Marital status
-
-
single
Husband's name
(single, married, widowed, divorced)
Permanent address 2106 North Van Buren St. Little Rock- Pulaski
Arkansas.
(street)
(city)
(county)
(state)
Present address
Same
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
Mrs Mamie I. Beauchamp -2106. N. Van Buren St Little Rock, Arkansas
nother-
(name)
(address)
(relationship)
Are you employed in nursing at the present time? Yes
No
If employed, check the type of work you are doing and fill in below the title of your position and the name
and address of the agency or institution:
Institutional
Public Health
Industrial
Private Duty
Other
Teaching Home Nursing
Pulaski County Chapter, American Red Cross- 321 West 18th. St. Little Rock, Arkansas.
If not employed, what type of nursing would you prefer to render?
IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND
ANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX
AVAILABILITY FOR SERVICE WITH THE ARMED FORCES
Requirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She
may be single or married, but if married she must have no dependents under 14 years of age.
If eligible and not already in service with the armed forces, are you:
Immediately available?
Available in the near future?
No
(specify date)
Not available, for the following reason?
Age
(specify)
Do you have any dependents under 14 years of age? Yes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes? Yes active in this field at present
To teach volunteer nurse's aides?
No-
To take a Red Cross emergency assignment? Yes
To serve overseas caring for civilians?
No
Have you ever served with the Red Cross in a disaster? Yes
No
If yes, specify type of disaster Floods- Tornado-
MY
(stada)
(vili)
8
Page data
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- Source index
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- Type
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Document data
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- Core
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"ocrText": "FORM 1045\nREV.OCT.1943\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nseY\n101\nox oc\nRed Cross\nIte\nIf you have changed your last name\nBadge number\n30 281\nsince contacting us, please check here.\nName in full Beauchamp\nlinnie\nTel. No. Office: 4-6315\n(last)\n(first)\n(middle)\nRes:3-1059\nIf married, give maiden name\n-\nDate of birth April 23, 1892\nMarital status\n-\n-\nsingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 2106 North Van Buren St. Little Rock- Pulaski\nArkansas.\n(street)\n(city)\n(county)\n(state)\nPresent address\nSame\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\nMrs Mamie I. Beauchamp -2106. N. Van Buren St Little Rock, Arkansas\nnother-\n(name)\n(address)\n(relationship)\nAre you employed in nursing at the present time? Yes\nNo\nIf employed, check the type of work you are doing and fill in below the title of your position and the name\nand address of the agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nTeaching Home Nursing\nPulaski County Chapter, American Red Cross- 321 West 18th. St. Little Rock, Arkansas.\nIf not employed, what type of nursing would you prefer to render?\nIT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND\nANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX\nAVAILABILITY FOR SERVICE WITH THE ARMED FORCES\nRequirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She\nmay be single or married, but if married she must have no dependents under 14 years of age.\nIf eligible and not already in service with the armed forces, are you:\nImmediately available?\nAvailable in the near future?\nNo\n(specify date)\nNot available, for the following reason?\nAge\n(specify)\nDo you have any dependents under 14 years of age? Yes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes? Yes active in this field at present\nTo teach volunteer nurse's aides?\nNo-\nTo take a Red Cross emergency assignment? Yes\nTo serve overseas caring for civilians?\nNo\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nIf yes, specify type of disaster Floods- Tornado-\nMY\n(stada)\n(vili)\n8"
}