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FORM 1045
AMERICAN RED CROSS
REV. DEC. 1939
NATIONAL HEADQUARTERS
WASHINGTON, D.C.
is
Name in full Cunmings (SURNAME)
Verda
Violet
(FIRST)
(MIDDLE)
/
Husband's name Single
Permanent address 930 n.W. 20th are Portland, multnomah Oregon
e
a
(STREET)
(CITY)
(COUNTY)
(STATE)
a
Probable address
for the next year
930 n.w.201 are Portland, Multurant Oregon
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
(EXCHANGE)
(NO.)
Nearest relative or friend in United States, through whom you may be communicated with in
an emergency:
MM It (NAME) At Cummings
father
(RELATIONSHIP)
34345.8.82 nd st.
Portland
(CITY)
Oregon
(STREET)
(STATE)
PRESENT WORK (check below)
Name of agency or institution with which employed
Institutional
nurnes Official Regestry
Public Health
Private duty
X
Other (write in)
Government Service: Army
U.S.P.H.Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
IF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other (write in)
Would you respond to an emergency call in event of local or national emergency, such as
epidemic, flood, war, etc.
(Granted of course that you could be released from present employment)
yes
Present physical condition
good
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
Are a member of the Association?
you American Nurses' yes
If not, why have you allowed your membership to lapse?
:
Badge No. 40,156
1940
Current date
Name of Committee
Oregon State E Local
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.
of
Page data
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- Source index
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- Type
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Document data
- ID
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- Core
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"ocrText": "FORM 1045\nAMERICAN RED CROSS\nREV. DEC. 1939\nNATIONAL HEADQUARTERS\nWASHINGTON, D.C.\nis\nName in full Cunmings (SURNAME)\nVerda\nViolet\n(FIRST)\n(MIDDLE)\n/\nHusband's name Single\nPermanent address 930 n.W. 20th are Portland, multnomah Oregon\ne\na\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\na\nProbable address\nfor the next year\n930 n.w.201 are Portland, Multurant Oregon\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\n(EXCHANGE)\n(NO.)\nNearest relative or friend in United States, through whom you may be communicated with in\nan emergency:\nMM It (NAME) At Cummings\nfather\n(RELATIONSHIP)\n34345.8.82 nd st.\nPortland\n(CITY)\nOregon\n(STREET)\n(STATE)\nPRESENT WORK (check below)\nName of agency or institution with which employed\nInstitutional\nnurnes Official Regestry\nPublic Health\nPrivate duty\nX\nOther (write in)\nGovernment Service: Army\nU.S.P.H.Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nIF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nWould you respond to an emergency call in event of local or national emergency, such as\nepidemic, flood, war, etc.\n(Granted of course that you could be released from present employment)\nyes\nPresent physical condition\ngood\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nAre a member of the Association?\nyou American Nurses' yes\nIf not, why have you allowed your membership to lapse?\n:\nBadge No. 40,156\n1940\nCurrent date\nName of Committee\nOregon State E Local\nNote:\nIf 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.\nof"
}