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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

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79
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0
Type
photo
Media ID
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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"
}