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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
55720
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
S
TELEPHONE NO.
NAME (Last, first, middle)
BEUCHAT, JOSEPHINE DORA
Dr. 2251
HUSBAND'S NAME
IF MARRIED, GIVE MAIDEN NAME
PERMANENT ADDRESS (Street, city, zone, county, state)
Louisville, Ohio
PRESENT ADDRESS (Street, city, zone, county, state)
2530 W. Eight ST. L.a.5
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
Joseph P. BeuchaT Louisville, ohio
Father
DATE OF BIRTH (Month, day, year)
(Single
Married
Separated
Widowed
Divorced
mag 29, 1909
YES
NO
WHAT LANGUAGES DO YOU SPEAK?
HIGH SCHOOL GRADUATE
English
0
DEGREE OR
NAME OF COLLEGE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
PHN DIPLOMA
MAJOR
1931-32
CerTi ficale
a
Western Reserve University cleveland, ohio 1936-38
BS nursing Public Hearth
YES
NO
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
ARE YOU CURRENTLY
REGISTERED IN (State)
REGISTERED?
x
Ohio, Calif
NURSES' ASSOCIATION?
X
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
Supervisor- una
Public Health
CITY
STATE
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
Visitorif nurse anae. of for Rufeles, Inc.
for angeles 5 Calif.
HEALTH
IF OTHER THAN GOOD, SPECLFY 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 willing and able to
serve if called on within the next 12 nths.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
1200 Vermont are. for angles ealif.
Attend an instructors' training program, if'offered. (Funds are available for
YES
NO
1. Teach home
YES
NO
nursing classes
X
training home nursing instructors. See local chapter.)
X
2. Serve in case
NO
only in home community
Attend disaster institutes, if
YES
NO
YES
of disaster
In other communities
offered, in preparation for service
YES
NO
5. Assist with other chapter
YES
NO
3. Teach nurse's
YES
NO
4. Accept membership on chapter com-
aide classes
nittee 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-
5
DATE
S IGNATURE
November 3, 1945
Josephine D. Beuchat
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILINGNESS TO SERVE AND YOUR FAITHPOLNESS IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
COMMITTEE NAMED BELOW.
J
ATTENTION
Fill in committee name and admess Hefer D. to nurse.
Recruitment
1/1/16
2
SECRETARY
NURSE RECRUITMENT
American Red Cross, Los Angeles Chapter
a
COMMITTEE
1200 South Vermont Ave., Los Angeles 6, Califernia
78504M
FORM 1045 Rev. July 1945
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"ocrText": "B\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n55720\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nS\nTELEPHONE NO.\nNAME (Last, first, middle)\nBEUCHAT, JOSEPHINE DORA\nDr. 2251\nHUSBAND'S NAME\nIF MARRIED, GIVE MAIDEN NAME\nPERMANENT ADDRESS (Street, city, zone, county, state)\nLouisville, Ohio\nPRESENT ADDRESS (Street, city, zone, county, state)\n2530 W. Eight ST. L.a.5\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nJoseph P. BeuchaT Louisville, ohio\nFather\nDATE OF BIRTH (Month, day, year)\n(Single\nMarried\nSeparated\nWidowed\nDivorced\nmag 29, 1909\nYES\nNO\nWHAT LANGUAGES DO YOU SPEAK?\nHIGH SCHOOL GRADUATE\nEnglish\n0\nDEGREE OR\nNAME OF COLLEGE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nPHN DIPLOMA\nMAJOR\n1931-32\nCerTi ficale\na\nWestern Reserve University cleveland, ohio 1936-38\nBS nursing Public Hearth\nYES\nNO\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nARE YOU CURRENTLY\nREGISTERED IN (State)\nREGISTERED?\nx\nOhio, Calif\nNURSES' ASSOCIATION?\nX\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nSupervisor- una\nPublic Health\nCITY\nSTATE\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nVisitorif nurse anae. of for Rufeles, Inc.\nfor angeles 5 Calif.\nHEALTH\nIF OTHER THAN GOOD, SPECLFY 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\nparticipate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able to\nserve if called on within the next 12 nths.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n1200 Vermont are. for angles ealif.\nAttend an instructors' training program, if'offered. (Funds are available for\nYES\nNO\n1. Teach home\nYES\nNO\nnursing classes\nX\ntraining home nursing instructors. See local chapter.)\nX\n2. Serve in case\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nYES\nof disaster\nIn other communities\noffered, in preparation for service\nYES\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\naide classes\nnittee 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-\n5\nDATE\nS IGNATURE\nNovember 3, 1945\nJosephine D. Beuchat\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILINGNESS TO SERVE AND YOUR FAITHPOLNESS IN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nJ\nATTENTION\nFill in committee name and admess Hefer D. to nurse.\nRecruitment\n1/1/16\n2\nSECRETARY\nNURSE RECRUITMENT\nAmerican Red Cross, Los Angeles Chapter\na\nCOMMITTEE\n1200 South Vermont Ave., Los Angeles 6, Califernia\n78504M\nFORM 1045 Rev. July 1945"
}