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Coop the Biloke
diridg Co neiss
DEC 1 5 1943
FORM 1045
ROO REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
JAN 18-1944 -
ANNUAL QUESTIONNAIRE-1944
RRED
TO
Red Cross
If you have changed your last name
Badge number
17721
since contacting us, please check here.
Name in full Carothers Dna
C
Tel. No.
(last)
(first)
(middle)
If married, give maiden name
Date of birth July 27- 1882
Marital status
single
Husband's name
(single, married, widowed, divorced)
address RFD#1 Cutler Washington
Olio
Permanent
(street)
(city)
(county)
(state)
Present address Veterans (street) adm Ficility (city) Bilops Harrism (county)
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
games (name) a Carothers RFD#1 (address) Cutter Olio
Father
(relationship)
Are you employed in nursing at the present time? Yes
No
If employed, check the type of work you are doing and fill in below the title of your position and the name
and address of the agency or institution:
Institutional
Public Health
Industrial
Private Duty
Other
Staff Thurse Veterans adm. Facility, Biloge miss.
If
not employed, what type of nursing would you prefer to render?
IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND
ANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX
AVAILABILITY FOR SERVICE WITH THE ARMED FORCES
Requirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She
may be single or married, but if married she must have no dependents under 14 years of age.
If eligible and not already in service with the armed forces, are you:
Immediately available?
Available in the near future?
(specify date)
Not available, for the following reason?
(specify)
Do you have any dependents under 14 years of age? Yes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
To serve overseas caring for civilians?
Have you ever served with the Red Cross in a disaster? Yes
No
If yes, specify type of disaster
Page data
- Page
- 111
- Source index
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- Type
- photo
- Media ID
- 9ea84a1a20b3a2ba
- Size
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Document data
- ID
- 2661219
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "Coop the Biloke\ndiridg Co neiss\nDEC 1 5 1943\nFORM 1045\nROO REV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nJAN 18-1944 -\nANNUAL QUESTIONNAIRE-1944\nRRED\nTO\nRed Cross\nIf you have changed your last name\nBadge number\n17721\nsince contacting us, please check here.\nName in full Carothers Dna\nC\nTel. No.\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate of birth July 27- 1882\nMarital status\nsingle\nHusband's name\n(single, married, widowed, divorced)\naddress RFD#1 Cutler Washington\nOlio\nPermanent\n(street)\n(city)\n(county)\n(state)\nPresent address Veterans (street) adm Ficility (city) Bilops Harrism (county)\n(state)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\ngames (name) a Carothers RFD#1 (address) Cutter Olio\nFather\n(relationship)\nAre you employed in nursing at the present time? Yes\nNo\nIf employed, check the type of work you are doing and fill in below the title of your position and the name\nand address of the agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nStaff Thurse Veterans adm. Facility, Biloge miss.\nIf\nnot employed, what type of nursing would you prefer to render?\nIT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND\nANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX\nAVAILABILITY FOR SERVICE WITH THE ARMED FORCES\nRequirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She\nmay be single or married, but if married she must have no dependents under 14 years of age.\nIf eligible and not already in service with the armed forces, are you:\nImmediately available?\nAvailable in the near future?\n(specify date)\nNot available, for the following reason?\n(specify)\nDo you have any dependents under 14 years of age? Yes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\nTo serve overseas caring for civilians?\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nIf yes, specify type of disaster"
}