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9- n
FORM 1045
REV. DEC. 1939
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D.C.
Name in full
Bouling (SURNAME) (min) Gertuule (FIRST) Hayden
(MIDDLE)
-
Husband's name
Permanent
address Hughes bille (CITY) Charles Cently (COUNTY) maryland (STATE)
(STREET)
Probable the next address 810 alls Bldg 1426 Esvn. W. Wash D.C.
for year
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone
number met 5246
(EXCHANGE)
(NO.)
Nearest relative or friend in United States, through whom you may be communicated with in
I
an emergency:
mes games (NAME) m. Borling
mother
(RELATIONSHIP)
2410 Cleinore OnE Baltemas mary land
(STREET)
(CITY)
(STATE)
PRESENT WORK (check below)
Name of agency or institution with which employed
Institutional
Public Health
Exec Director Induction Visiting nurse Society
which D.C.
Private duty
Other (write in)
Government Service: Army
U.S.P.H.Service
Veterans Administration
Navy
U.S. Indian Service
Children's Bureau
IF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other (write in)
Would you respond to an emergency call in event of local or national emergency, such as
epidemic, flood, war, etc.
yes
(Granted of course that you could be released from present employment)
Present physical
condition Very good
-
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
Are you a member of the American Nurses' Association? yes
-
If not, why have you allowed your membership to lapse?
Badge
No. 725111
Current date
2/19/40
Name of
Committee DIST.
OF COLUMBIA
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enrollment will be removed from our active files.
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"ocrText": "9- n\nFORM 1045\nREV. DEC. 1939\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D.C.\nName in full\nBouling (SURNAME) (min) Gertuule (FIRST) Hayden\n(MIDDLE)\n-\nHusband's name\nPermanent\naddress Hughes bille (CITY) Charles Cently (COUNTY) maryland (STATE)\n(STREET)\nProbable the next address 810 alls Bldg 1426 Esvn. W. Wash D.C.\nfor year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone\nnumber met 5246\n(EXCHANGE)\n(NO.)\nNearest relative or friend in United States, through whom you may be communicated with in\nI\nan emergency:\nmes games (NAME) m. Borling\nmother\n(RELATIONSHIP)\n2410 Cleinore OnE Baltemas mary land\n(STREET)\n(CITY)\n(STATE)\nPRESENT WORK (check below)\nName of agency or institution with which employed\nInstitutional\nPublic Health\nExec Director Induction Visiting nurse Society\nwhich D.C.\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H.Service\nVeterans Administration\nNavy\nU.S. Indian Service\nChildren's Bureau\nIF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nWould you respond to an emergency call in event of local or national emergency, such as\nepidemic, flood, war, etc.\nyes\n(Granted of course that you could be released from present employment)\nPresent physical\ncondition Very good\n-\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nAre you a member of the American Nurses' Association? yes\n-\nIf not, why have you allowed your membership to lapse?\nBadge\nNo. 725111\nCurrent date\n2/19/40\nName of\nCommittee DIST.\nOF COLUMBIA\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enrollment will be removed from our active files."
}