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(100:
Registered in State of Illinois
Date 11/1909
D
Languages spoken (underline those spoken fluently)
11
Available for service in event of war
Yes.
If not, why?
ct
Available for service in home community in time of emergency Yes.
If not, why?
ON
19
ENTERED de MONTHS COURSE AT
(NAME OF INSTITUTION)
MONTH AND DAY
COURSE TAKEN ON LOAN SCHOLARSHIP PAID FOR FROM NATIONAL HEADQUARTERS.
COURSE COMPLETED ON
CHAPTER FUNDS,
19
NAME
(MONTH AND DAY)
SERVICE RECORD
APPOINTED
SERVICE TERMINATED
RESIGNED
TRANS-
DATE
NAME OF SERVICE
ADDRESS OF NURSE
SALARY
DATE
TRANSFERRED
REASON
PORTATION
OR DISMISSED
6/2/19
A.R:C. Siberia
a
the
Service questionnaire returned 7-1-22. Health Excellent - No compensation.
How and where employed since graduation
Give dates with months
Name and address of employers
Private duty,
2/1904-9/1/1910
Edward: Sanatorium,
9/1/10-1/1/11
Private duty
2/1911-9/24/11
Infant Welfare Society, Chicago, Ill.
0/24/11-11/27/11
Private Nursing, Brooklyn, New York, 1922.
Check any of following in which experience has been had and time in each:
General visiting nursing
Municipal nursing
Infant welfare nursing
x
Industrial nursing
Tuberculosis nursing
Social service nursing
School nursing
Other
Special course in public health nursing or social service work, state where, and between what dates:
Preference as to locality
Kind of work desired
Salary desired
Religion
u
5
I
6
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"ocrText": "(100:\nRegistered in State of Illinois\nDate 11/1909\nD\nLanguages spoken (underline those spoken fluently)\n11\nAvailable for service in event of war\nYes.\nIf not, why?\nct\nAvailable for service in home community in time of emergency Yes.\nIf not, why?\nON\n19\nENTERED de MONTHS COURSE AT\n(NAME OF INSTITUTION)\nMONTH AND DAY\nCOURSE TAKEN ON LOAN SCHOLARSHIP PAID FOR FROM NATIONAL HEADQUARTERS.\nCOURSE COMPLETED ON\nCHAPTER FUNDS,\n19\nNAME\n(MONTH AND DAY)\nSERVICE RECORD\nAPPOINTED\nSERVICE TERMINATED\nRESIGNED\nTRANS-\nDATE\nNAME OF SERVICE\nADDRESS OF NURSE\nSALARY\nDATE\nTRANSFERRED\nREASON\nPORTATION\nOR DISMISSED\n6/2/19\nA.R:C. Siberia\na\nthe\nService questionnaire returned 7-1-22. Health Excellent - No compensation.\nHow and where employed since graduation\nGive dates with months\nName and address of employers\nPrivate duty,\n2/1904-9/1/1910\nEdward: Sanatorium,\n9/1/10-1/1/11\nPrivate duty\n2/1911-9/24/11\nInfant Welfare Society, Chicago, Ill.\n0/24/11-11/27/11\nPrivate Nursing, Brooklyn, New York, 1922.\nCheck any of following in which experience has been had and time in each:\nGeneral visiting nursing\nMunicipal nursing\nInfant welfare nursing\nx\nIndustrial nursing\nTuberculosis nursing\nSocial service nursing\nSchool nursing\nOther\nSpecial course in public health nursing or social service work, state where, and between what dates:\nPreference as to locality\nKind of work desired\nSalary desired\nReligion\nu\n5\nI\n6"
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