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May 27, 1941
FORM 1045
#22426 (mh)
REV. JAN 1941
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
Name in full Borland Jane S Conover (Year of Birth
1889
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name Borland
Wm.
James,
Permanent 1428 address Meridianil Wash.
D. .C.
L
S
(STREET)
(CITY)
(COUNTY)
(STATE)
0
Probable address
for the next year 428meridian Pl. Wash
K
D.C.
e
J
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number Columbia 5696
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
Wm. J Borland Husband
same
(NAME)
(RELATIONSHIP)
(ADDRESS)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
C
0
Institutional
5
Public Health
Private duty
C
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
J.S.Indian Service
Children's Bureau
et
MAJOR RESPONSIBILITIES Adminis
Super
Teach-
General
Private
Other
of present employment tration
vision
ing
Staff
Duty
(specify)
IF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty V Other
(WRITE IN)
AVAILABILITY
At the present time would you
Date
accept assignment to the Army? Yes
No
Navy? Yes
No
available
In case of a war emergency would you
accept assignment to the Army? Yes
No
Navy? Yes
No
If not now employed would you
accept nursing work? Full-time? Yes
No
Part-time? Yes
No
In your own community? Yes
No
Elsewhere? Yes
No
secletter 6-241
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
no
Present physical condition good.
Badge No. 22426
Current date June
I
N
Name of Committee NATIONAL HEADGUARTERS
Note: If a nurse does not complete and return this questionnaire, and cannot be located
L
within two years, her enrollment will be removed from our active files.
U
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Document data
- ID
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- Core
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- Type
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"ocrText": "May 27, 1941\nFORM 1045\n#22426 (mh)\nREV. JAN 1941\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\nName in full Borland Jane S Conover (Year of Birth\n1889\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name Borland\nWm.\nJames,\nPermanent 1428 address Meridianil Wash.\nD. .C.\nL\nS\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\n0\nProbable address\nfor the next year 428meridian Pl. Wash\nK\nD.C.\ne\nJ\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number Columbia 5696\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nWm. J Borland Husband\nsame\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nC\n0\nInstitutional\n5\nPublic Health\nPrivate duty\nC\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nJ.S.Indian Service\nChildren's Bureau\net\nMAJOR RESPONSIBILITIES Adminis\nSuper\nTeach-\nGeneral\nPrivate\nOther\nof present employment tration\nvision\ning\nStaff\nDuty\n(specify)\nIF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty V Other\n(WRITE IN)\nAVAILABILITY\nAt the present time would you\nDate\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable\nIn case of a war emergency would you\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\nIf not now employed would you\naccept nursing work? Full-time? Yes\nNo\nPart-time? Yes\nNo\nIn your own community? Yes\nNo\nElsewhere? Yes\nNo\nsecletter 6-241\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nno\nPresent physical condition good.\nBadge No. 22426\nCurrent date June\nI\nN\nName of Committee NATIONAL HEADGUARTERS\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nL\nwithin two years, her enrollment will be removed from our active files.\nU"
}