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Form 1045
Rev. Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
Name
If married,
in full give Colden maiden (last) name. (first) Pattainer Pollendon (middle) Yorking Tel. Year No. of birth 1888 it V
Mary
Mary
Marital status
Husband's name
Permanent
Probable
for the next
address year (street) Men Hasp., (city) 80 legalith (country) n.J. (state) linion County
address (single, (street) married widowed, divorced) Honual (city) Harp county) lenion Samuely (state) New Juny
Elizabelh
Stephen
Give name of nearest relative or in United
(name) land address Edwardsin (relationship) friend States: (address) new Jersey
Are you employed in nursing at the present time? Yes
No
PRESENT EMPLOYMENT (check below) Name of agent or institution (with which employed
Institutional
Eleigabeth Menual Hosp Elizabeth New Jerry
Public health
Industrial
Private duty
Other (write in)
was Service
Government Service: Army, Regular
Reserve
2yrs sam Navy, Regular Reserve
10 yrs.
Veterans Administration
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)
anewaria
How many years did you attend HIGH SCHOOL? One
Two
Three
Four
Graduated
Yes
No
SINCE GRADUATION FROM YOUR SCHOOL OF NURSING
SACIAL 89A
have you ever had-
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
115yrs.
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? Social Since
What languages, other than English, do you speak? None
and
(OVER)
* Academic year
Page data
- Page
- 79
- Source index
- 0
- Type
- photo
- Media ID
- fe453d554b459589
- Size
- unknown
Document data
- ID
- 2661199
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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Document source metadata
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Document source extras
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Page context
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"ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName\nIf married,\nin full give Colden maiden (last) name. (first) Pattainer Pollendon (middle) Yorking Tel. Year No. of birth 1888 it V\nMary\nMary\nMarital status\nHusband's name\nPermanent\nProbable\nfor the next\naddress year (street) Men Hasp., (city) 80 legalith (country) n.J. (state) linion County\naddress (single, (street) married widowed, divorced) Honual (city) Harp county) lenion Samuely (state) New Juny\nElizabelh\nStephen\nGive name of nearest relative or in United\n(name) land address Edwardsin (relationship) friend States: (address) new Jersey\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agent or institution (with which employed\nInstitutional\nEleigabeth Menual Hosp Elizabeth New Jerry\nPublic health\nIndustrial\nPrivate duty\nOther (write in)\nwas Service\nGovernment Service: Army, Regular\nReserve\n2yrs sam Navy, Regular Reserve\n10 yrs.\nVeterans Administration\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)\nanewaria\nHow many years did you attend HIGH SCHOOL? One\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nSACIAL 89A\nhave you ever had-\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\n115yrs.\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\nwhat major field was above study? Social Since\nWhat languages, other than English, do you speak? None\nand\n(OVER)\n* Academic year"
}