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FORM 1045
REV. JAN 1941
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
rs.
Name
in full young (SURNAME) Florence (FIRST) Viola (MIDDLE)
Year of Birth 1906
F
Husband's name
Permanent
address 1135 (STREET) Seveenland (CITY) Wx, Burbank, (cbunty) Leslingles, California (STATE
L
0
T
Probable
O
e
for
the next address year 1710 (STREET) W 6th.St, Los (CITY) Engeles, (COUNTY) Los Angeles, Calif- (STATE)
-
5
a
C
Telephone number
Drexel
2246
e
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
/
Lawrence (NAME) young brother, (RELATIONSHIP) 1608 Cahuenga (ADDRESS) Blud., Hollywood,
/
Calif -
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
Hospital of the Good Samari tan,
Public Health
Los angeles.
Private duty
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
U.S.Indian Service.
Children's Bureau
MAJOR ESPONSIBILITIES 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
Other
(WRITE IN}
AVAILABILITY
At the present time would you
ifnereous
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
Would you be interested in teaching classes in Home Hygiene and Care of the Sick? no
Present physical condition
Good
u
Badge
No. 62226
Current date
3-8-41
Name
e
a
of Committee
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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- Type
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- Media ID
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Document data
- ID
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- Core
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- Type
- document
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"ocrText": "ztt)\nFORM 1045\nREV. JAN 1941\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nrs.\nName\nin full young (SURNAME) Florence (FIRST) Viola (MIDDLE)\nYear of Birth 1906\nF\nHusband's name\nPermanent\naddress 1135 (STREET) Seveenland (CITY) Wx, Burbank, (cbunty) Leslingles, California (STATE\nL\n0\nT\nProbable\nO\ne\nfor\nthe next address year 1710 (STREET) W 6th.St, Los (CITY) Engeles, (COUNTY) Los Angeles, Calif- (STATE)\n-\n5\na\nC\nTelephone number\nDrexel\n2246\ne\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\n/\nLawrence (NAME) young brother, (RELATIONSHIP) 1608 Cahuenga (ADDRESS) Blud., Hollywood,\n/\nCalif -\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nHospital of the Good Samari tan,\nPublic Health\nLos angeles.\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nU.S.Indian Service.\nChildren's Bureau\nMAJOR ESPONSIBILITIES Adminis-\nSuper\nTeach\nGeneral\nPrivate\nOther\nof present employment tration\nvision\ning\nStaff\nDuty\n(specify)\nIF\nNOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther\n(WRITE IN}\nAVAILABILITY\nAt the present time would you\nifnereous\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\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick? no\nPresent physical condition\nGood\nu\nBadge\nNo. 62226\nCurrent date\n3-8-41\nName\ne\na\nof Committee\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."
}