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FORM 1045
REV. JAN 1941
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
Name in full Bush
(SURNAME)
Sarah (FIRST) gertrude (MIDDLE) Year of Birth
1888
Husband's name
Permanent address
192 E Como Are Columbus Franklin
Ohio
(STREET)
(CITY)
(COUNTY)
(STATE)
G
Probable address
same
e
for the next year
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
La
6915
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
Bush EllAMrs. Mother
132 E. Como Ave Columbus G
(NAME)
(RELATIONSHIP)
(ADDRESS)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
Public Health
Ohio wept of Health
Private duty
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
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
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? No
U
Present physical condition go
Badge No. 20614
Columbus Ohw
Current date Jan-24-1940
Name 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.
Page data
- Page
- 21
- Source index
- 0
- Type
- photo
- Media ID
- 04e5a7d74ba23288
- Size
- unknown
Document data
- ID
- 2661190
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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"ocrText": "B\nFORM 1045\nREV. JAN 1941\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\nName in full Bush\n(SURNAME)\nSarah (FIRST) gertrude (MIDDLE) Year of Birth\n1888\nHusband's name\nPermanent address\n192 E Como Are Columbus Franklin\nOhio\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nG\nProbable address\nsame\ne\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\nLa\n6915\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nBush EllAMrs. Mother\n132 E. Como Ave Columbus G\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nPublic Health\nOhio wept of Health\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\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\nOther\n(WRITE IN)\nAVAILABILITY\nAt the present time would you\nDate\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable\nIn\ncase 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\nU\nPresent physical condition go\nBadge No. 20614\nColumbus Ohw\nCurrent date Jan-24-1940\nName of 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."
}