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u
=
FORM 1045
REV. JAN 1941
R
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
F
WASHINGTON, D. C.
Name
in full AC Bullard. florence thuch Year of Birth 1888
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
Permanent address Pendell (STREET) Rd. Prighteefair ACITY) Dutchess. (COUNTY) newern (STATE)
Probable
for the
next address year Pendell Rd. Poughturpaie Dutchus.
(STREET)
(CITY)
(COUNTY)
newyork.
(STATE)
Telephone number Poug
Huppair
2566
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
Mrs. (NAME) H St.John Williams. (RELATIONSHIP) friend Pendue Rd. (ADDRESS)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
L
Public Health
Sanil t luttic Boone Hoopt Paughterpou
Private duty
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
MAJOR RESPONSIBILITI
Jinis
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
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?
Present physical condition
good.
Badge No.
6741.
Name of Committee
Paughkergain, n.y
Current date tay. 26.141.
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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Document data
- ID
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- Core
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- Type
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DTO data
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"ocrText": "B\nu\n=\nFORM 1045\nREV. JAN 1941\nR\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nF\nWASHINGTON, D. C.\nName\nin full AC Bullard. florence thuch Year of Birth 1888\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent address Pendell (STREET) Rd. Prighteefair ACITY) Dutchess. (COUNTY) newern (STATE)\nProbable\nfor the\nnext address year Pendell Rd. Poughturpaie Dutchus.\n(STREET)\n(CITY)\n(COUNTY)\nnewyork.\n(STATE)\nTelephone number Poug\nHuppair\n2566\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nMrs. (NAME) H St.John Williams. (RELATIONSHIP) friend Pendue Rd. (ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nL\nPublic Health\nSanil t luttic Boone Hoopt Paughterpou\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nMAJOR RESPONSIBILITI\nJinis\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\nOther\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\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nPresent physical condition\ngood.\nBadge No.\n6741.\nName of Committee\nPaughkergain, n.y\nCurrent date tay. 26.141.\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."
}