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N I e. P L in e L paw 0 9 + IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND CHECK THE APPROPRIATE BOX AVAILABILITY FOR SERVICE WITH THE ARMED FORCES a M Requirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be- H 7 Physically fit, single, and under 40. 1 a For assignment to the Army Nurse Corps, a Red Cross nurse must be- L Physically fit, single OR married, and under 40. If qualified for supervision, anaesthesia, operating room work, or interested in overseas assignment, the age limit is the 45th a birthday. < If eligible and not already in service, are you t 5 Immediately available Available in the near future (specify date) ra a Not available for the following reasons (specify) If married, do you have minor dependents? H (specify) If the Army decides to accept nurses from 40 to 44 years of age (inclusive) for all assignments, would you be Immediately available Available in the near future (specify date) Not available for the following reasons (specify) AVAILABILITY FOR SERVICE WITH CIVILIANS If not already doing so, will you present Teach Red Cross Home Nursing classes, if qualified? Termination of employmen Teach Volunteer Nurse's Aides, if qualified? Serve with an overseas unit caring for civilian casualties? no Be available for emergency Red Cross assignments? yes 10 100H98 2007 Mom PHYSICAL CONDITION Have you been rejected for military service? Yes No Why? Do you believe that you could now meet revised physical requirements for military service? Yes No overage State present physical condition good If any disabilities, please specify none Red Cross Badge No. 37892 January 4.1943 form is filled this in) (to be filled in by committee before questionnaire is sent to the nurse) YOUR VALUE AS A RED CROSS RESERVE NURSE DEPENDS ON OUR ABILITY TO LOCATE YOU. THE NATIONAL EMERGENCY EMPHASIZES THIS FACT MORE THAN EVER. THANK YOU FOR FILLING IN THIS QUESTIONNAIRE AND RETURNING IT TO US.

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