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FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
M
NURSING SERVICE
a
ANNUAL QUESTIONNAIRE-1944
Red Cross
If you have changed your last name
Badge number 71413
since contacting us, please check here.
an
Name in full Biltz (last),
Marian
(first)
Virginia
Tel. No. 4728m
(middle)
If married, give maiden name
Date of birth mar. 4, 1915
L
Marital status
Single
Husband's name
(single, (married, widowed, divorced)
Permanent address
934 (street) 4thSt. Mishawaka (city) (county) Joseph Indiana (state)
E.
1
Hawmond
9
Present address
a Ruth
wake
Indiana
(street)
(city)
(county)
(state)
944
5
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
a
Mr. (name) George's Biltz
934 E. 4th H. Mishawaka Ind.
father
(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
Assistant Mirector of Nurces St. margaret Hospital Hawnord, Ind.
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?
(specify date)
Not available, for the following reason?
Essential position (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? no
To teach volunteer nurse's aides? yes
To take a Red Cross emergency assignment? yes
To serve overseas caring for civilians? Yes
Have you ever served with the Red Cross in a disaster? Yes
No
If yes, specify type of disaster flood areas
Page data
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- Type
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Document data
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- Core
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"ocrText": "B\n-\n+\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nM\nNURSING SERVICE\na\nANNUAL QUESTIONNAIRE-1944\nRed Cross\nIf you have changed your last name\nBadge number 71413\nsince contacting us, please check here.\nan\nName in full Biltz (last),\nMarian\n(first)\nVirginia\nTel. No. 4728m\n(middle)\nIf married, give maiden name\nDate of birth mar. 4, 1915\nL\nMarital status\nSingle\nHusband's name\n(single, (married, widowed, divorced)\nPermanent address\n934 (street) 4thSt. Mishawaka (city) (county) Joseph Indiana (state)\nE.\n1\nHawmond\n9\nPresent address\na Ruth\nwake\nIndiana\n(street)\n(city)\n(county)\n(state)\n944\n5\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\na\nMr. (name) George's Biltz\n934 E. 4th H. Mishawaka Ind.\nfather\n(address)\n(relationship)\nAre you employed in nursing at the present time? Yes\nNo\nIf\nemployed, 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\nAssistant Mirector of Nurces St. margaret Hospital Hawnord, Ind.\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?\n(specify date)\nNot available, for the following reason?\nEssential position (specify)\nDo you have any dependents under 14 years of age?\nYes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes? no\nTo teach volunteer nurse's aides? yes\nTo take a Red Cross emergency assignment? yes\nTo serve overseas caring for civilians? Yes\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nIf yes, specify type of disaster flood areas"
}