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Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS NURSING SERVICE Name in full Butler Ida F. Tel. No. 3,0641 (last) (first) (middle) If married, give maiden name Year of birth Marital status Husband's name (single, married, widowed, divorced) Permanent address 7 South Highland St Worst Hariful Harling S. Cours- (street) (city) (county) (state) Probable address for the next year The Same (street) (city) (county) (state) Give name and address of nearest relative or friend in United States: (name) 9. Butler nephew 204 Lane Unit Harifres Cun (relationship) (address) Are you employed in nursing at the present time? Yes No only Urhunties Service PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed Institutional Public health Industrial X Private duty Other (write in) Government Service: Army, Regular Navy, Regular Veterans Administration Reserve Reserve Children's Bureau U.S.P.H. Service U.S. Indian Service MAJOR RESPONSIBILITIES Administration Teaching Private duty of present employment Supervision General Staff Other (specify) How many years did you attend HIGH SCHOOL? One Two Three Four Graduated Yes No Exucated in princi and SINCE GRADUATION FROM YOUR SCHOOL OF NURSING have you ever had- Burding Schiols 1. A postgraduate course or experience in any of the following special services? Postgraduate course Experience in hospital in a hospital or public health field (at least 3 months) (at least 6 months) Communicable disease nursing (include Tbc) Psychiatric Nursing Operating room Anaesthesia Public health nursing 2. Have you taken any courses in a college or university? Less than One Two Three Four Bachelor's Master's P.H.D. Certificate in *one year year years years years degree degree degree Public Health In what major field was above study What Sme Funch 6-19-12 languages, other than English, do you speak? *Academic year (OVER)

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2661191
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Document identity
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        "month": 3,
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Page context
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    "ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName in full\nButler\nIda\nF.\nTel. No. 3,0641\n(last)\n(first)\n(middle)\nIf married, give maiden name\nYear of birth\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 7 South Highland St Worst Hariful Harling S. Cours-\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\nThe Same\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\n(name) 9. Butler\nnephew 204 Lane Unit Harifres Cun\n(relationship)\n(address)\nAre you employed in nursing at the present time? Yes\nNo\nonly Urhunties Service\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nIndustrial\nX\nPrivate duty\nOther (write in)\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL? One\nTwo\nThree\nFour\nGraduated\nYes\nNo\nExucated in princi and\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\nBurding Schiols\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nIn what major field was above study\nWhat Sme Funch\n6-19-12\nlanguages, other than English, do you speak?\n*Academic year\n(OVER)"
}