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FORM 1045 2 REV. JAN 1941 AMERICAN RED CROSS NATIONAL HEADQUARTERS WASHINGTON, D. c. I Name in full CORBIN Hark Year of Birth 1894 (SURNAME) (FIRST) (MIDDLE) Husband's name Permanent address 118 East 54* 3t. New Yark (STREET) (CITY) (COUNTY) (STATE) Probable address for the next year some (STREET) (CITY) (COUNTY) (STATE) Telephone number 2. 8226 (EXCHANGE) (NO.) Give name and address of nearest relative or friend in United States: e (NAME) (RELATIONSHIP) (ADDRESS) PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed Institutional Public Health Materinli Cerlin priocular Private duty New you. 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 (WRITE IN) AVAILABILITY Wised on the At the present time would you Date accept assignment to the Army? Yes No Navy? Yes No available need 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 you be interested in teaching classes in Home Hygiene and Care of the Sick? Present physical condition good Badge No. H2690 Current date 7el6-1941 Name of Committee MANHAITAN C 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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    "ocrText": "FORM 1045\n2\nREV. JAN 1941\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\nI\nName in full\nCORBIN\nHark\nYear of Birth 1894\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nPermanent address\n118 East 54* 3t. New Yark\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address\nfor the next year\nsome\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone\nnumber 2. 8226\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\ne\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nPublic Health\nMaterinli Cerlin priocular\nPrivate duty\nNew you.\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\n(WRITE IN)\nAVAILABILITY\nWised\non the\nAt the present time would you\nDate\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable need\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 you be interested in teaching classes in Home Hygiene and Care of the Sick?\nPresent physical condition good\nBadge No. H2690\nCurrent date 7el6-1941\nName of Committee\nMANHAITAN\nC\nNote: If 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."
}