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FORM 1045
REV. JAN 1941
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
Butler
Ida
F
Name in full
Year of Birth 1868
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
Permanent
address 7 South (STREET) Highland (CITY) St West Hariford (COUNTY) (STATE) Come
Probable address
for the next year
The Same
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
3-0641
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
M. Sames
9. Butter 204 Us. Quaker Lane Unst Hurefina
(NAME)
(RELATIONSHIP)
(ADDRESS)
Come
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
Hm Retired
Public 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 Administration
(WRITE IN)
AVAILABILITY
Run Cross none
At the present time would you
not Eligible
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 be interested no
you in teaching classes in Home Hygiene and Care of the Sick?
Present physical condition long ford
Badge No. 248
Current date
Name of Committee Hariford Committee
Ishany 2771
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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- Source index
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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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Context sent to Scholar
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"ocrText": "FORM 1045\nREV. JAN 1941\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nButler\nIda\nF\nName in full\nYear of Birth 1868\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent\naddress 7 South (STREET) Highland (CITY) St West Hariford (COUNTY) (STATE) Come\nProbable address\nfor the next year\nThe Same\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\n3-0641\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nM. Sames\n9. Butter 204 Us. Quaker Lane Unst Hurefina\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\nCome\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nHm Retired\nPublic 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 Administration\n(WRITE IN)\nAVAILABILITY\nRun Cross none\nAt the present time would you\nnot Eligible\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 be interested no\nyou in teaching classes in Home Hygiene and Care of the Sick?\nPresent physical condition long ford\nBadge No. 248\nCurrent date\nName of Committee Hariford Committee\nIshany 2771\nNote:\nIf 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."
}