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RED CROSS BADGE NUMBER
AMERICAN RED CROSo
694
NURSING SERVICES
MILITARY SERIAL NUMBER
D
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
TELEPHONE NO.
IF
MARRIED, Carter GIVE MAIDEN a. manry NAME
HUSBAND'S NAME
M
ADDRESS (Street, city, zone, county, state)
PERMANENT 311- So St. asaph it alexandrian Va
PRESENT ADDRESS (Street, city, zone, county, state)
same as above
NAME Mrs. AND ADDRESS G. In. OF Carter mother) 714 Succes Sh alex-Ve
NEAREST RELATIVE OR FRIEND IN THE UNITED-STATES
RELATIONSHIP
morter
DATE OF BIRTH (Month, day, year)
Single
Married
Separated-
Widowed
Divoreed
WHAT LANGUAGES DO YOU
Jan,2711881 SPEAK?
YES
NO
English
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
DEGREE OR
LOCATION
-
INCLUSIVE DATES
DIPLOMA
-
-
MAJOR
UNIVERSITY ATTENDED
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
NURSES' ASSOCIATION?
REGISTERED?
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D. inst., staff nurse, etc.) gov. clerk
SERVICE (Medicine, surgery, etc.)
CITY
STATE
NAME OF HOSPITAL U.S but BY WHOM administrative
OR ORGANIZATION
Naole
we
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
Fair
ah present recovering term break down
VOLUNT/ER SERVICE
The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call
to participate in a Red Cross chapter program. Please check the "Yes" box only if you are wi ling and able to
serve if called on within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
1. Teach home
TBC
NO
Attend an instructors' training program, 1f offered. (Funds are available for
YES
NO
nursing classes
training home nursing instructors. See local chapter.)
Attend disaster institutes, if
YES
NO
2. Serve in case
VES.
NO
only in home community
In other communities
offered, in preparation for service
of disaster
4. Accept membership on chapter cóm-
YES
NO
5. Assist with other chapter
YES
NO
3. Teach nurse's
YES
NO
aide classes
nittee should services be needed
programs, as needed
If have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you you will be able to serve in the future? ldo not know my months my notes
at some time
YOUR DATE aug VALUE AS A 20,1945 RED CROSS NURSE DEPENDS ON YOUR ABILITY S AND WILLINGNESS Many TO SERVE Carter AND YOUR FAITHPOLNESS
IF is UNABLE 89 years SERVE, GIVE old MAJOR & REASONS- my on age would IGNATURE prevent Rhave to help care
TO
IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
COMMITTEE NAMED BELOW.
a
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
DISTRICT OF COLUMBIA CHAPTER
NURSE RECRUITMENT
AMERICAN RED CROSS
10/31/155
COMMITTEE
1730 E STREET, N.W.
WASHINGTON, D.C.
FORM 1045 Rev. July 1945
78504M

Page data

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Document data

ID: 2661223
Core: doc
Type: document

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Document identity

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Page context

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    "ocrText": "actor\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSo\n694\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nD\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nIF\nMARRIED, Carter GIVE MAIDEN a. manry NAME\nHUSBAND'S NAME\nM\nADDRESS (Street, city, zone, county, state)\nPERMANENT 311- So St. asaph it alexandrian Va\nPRESENT ADDRESS (Street, city, zone, county, state)\nsame as above\nNAME Mrs. AND ADDRESS G. In. OF Carter mother) 714 Succes Sh alex-Ve\nNEAREST RELATIVE OR FRIEND IN THE UNITED-STATES\nRELATIONSHIP\nmorter\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nSeparated-\nWidowed\nDivoreed\nWHAT LANGUAGES DO YOU\nJan,2711881 SPEAK?\nYES\nNO\nEnglish\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nLOCATION\n-\nINCLUSIVE DATES\nDIPLOMA\n-\n-\nMAJOR\nUNIVERSITY ATTENDED\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nNURSES' ASSOCIATION?\nREGISTERED?\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D. inst., staff nurse, etc.) gov. clerk\nSERVICE (Medicine, surgery, etc.)\nCITY\nSTATE\nNAME OF HOSPITAL U.S but BY WHOM administrative\nOR ORGANIZATION\nNaole\nwe\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nFair\nah present recovering term break down\nVOLUNT/ER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are wi ling and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n1. Teach home\nTBC\nNO\nAttend an instructors' training program, 1f offered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\nAttend disaster institutes, if\nYES\nNO\n2. Serve in case\nVES.\nNO\nonly in home community\nIn other communities\noffered, in preparation for service\nof disaster\n4. Accept membership on chapter cóm-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\naide classes\nnittee should services be needed\nprograms, as needed\nIf have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou you will be able to serve in the future? ldo not know my months my notes\nat some time\nYOUR DATE aug VALUE AS A 20,1945 RED CROSS NURSE DEPENDS ON YOUR ABILITY S AND WILLINGNESS Many TO SERVE Carter AND YOUR FAITHPOLNESS\nIF is UNABLE 89 years SERVE, GIVE old MAJOR & REASONS- my on age would IGNATURE prevent Rhave to help care\nTO\nIN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\na\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nDISTRICT OF COLUMBIA CHAPTER\nNURSE RECRUITMENT\nAMERICAN RED CROSS\n10/31/155\nCOMMITTEE\n1730 E STREET, N.W.\nWASHINGTON, D.C.\nFORM 1045 Rev. July 1945\n78504M"
}

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