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B
ce-
S
E
FORM 1045
in
AMERICAN RED CROSS
REV. OCT. 1943
oM
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
on
soY TOT eveiled uov all
Red Cross
Badge number
24787
triallest
If you have changed your last name
blood
since contacting us, please check here.
N
ei
NM
Name in full
Bliss
Emily
Porter (Mrs.)
Tel. No. 8.1665
(last)
(first)
(middle)
If married, give maiden name Emily n. Porter
C
Date of birth meh.3.1880
Marital status
marrved
Husband's name Clarence T. Bliss.
(single, married, widowed, divorced)
Permanent address 183 Bradleyst new Haven Conn.
(county)
(state)
Present address
"
Nigh
Mrs.
M
(street)
(city)
"
"
(street)
(city)
(county)
C
(state)
Notify national headquarters immediately if you change your address.
II
Give name and address of nearest relative or friend in the United States:
+.)
C T. Bliss 183 Bradleyst Husband
(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 attourly only.
In the present everge - do two or
threacases a day-and house wife the rest of time
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?
(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:
2
To teach Red Cross Home Nursing classes?
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
To serve overseas caring for civilians?
Have you ever served with the Red Cross in a disaster Yes
No
If yes, specify type of disaster Over seas" in 1918 in greece. Refugees.
(alada)
in Toland Jyphns.
under American Foodadm-
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- Page
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- Source index
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- Type
- photo
- Media ID
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- Size
- unknown
Document data
- ID
- 2661123
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "B\nce-\nS\nE\nFORM 1045\nin\nAMERICAN RED CROSS\nREV. OCT. 1943\noM\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\non\nsoY TOT eveiled uov all\nRed Cross\nBadge number\n24787\ntriallest\nIf you have changed your last name\nblood\nsince contacting us, please check here.\nN\nei\nNM\nName in full\nBliss\nEmily\nPorter (Mrs.)\nTel. No. 8.1665\n(last)\n(first)\n(middle)\nIf married, give maiden name Emily n. Porter\nC\nDate of birth meh.3.1880\nMarital status\nmarrved\nHusband's name Clarence T. Bliss.\n(single, married, widowed, divorced)\nPermanent address 183 Bradleyst new Haven Conn.\n(county)\n(state)\nPresent address\n\"\nNigh\nMrs.\nM\n(street)\n(city)\n\"\n\"\n(street)\n(city)\n(county)\nC\n(state)\nNotify national headquarters immediately if you change your address.\nII\nGive name and address of nearest relative or friend in the United States:\n+.)\nC T. Bliss 183 Bradleyst Husband\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 attourly only.\nIn the present everge - do two or\nthreacases a day-and house wife the rest of time\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.\nShe\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?\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:\n2\nTo teach Red Cross Home Nursing classes?\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\nTo serve overseas caring for civilians?\nHave you ever served with the Red Cross in a disaster Yes\nNo\nIf yes, specify type of disaster Over seas\" in 1918 in greece. Refugees.\n(alada)\nin Toland Jyphns.\nunder American Foodadm-"
}