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a
<
is,
3
5
This side of card to be Alled in by committee from questionnaires or Form 876
Interested in
Available
teaching
Disaster
for
Present employment*
experience
military
H.N.
V.N.A.
Date
I
PH
PD
o
Type
Date
Yes
No
Yes
No
Yes
No
2/1/44
depend. mother, Not suailable
8/17/65
do
Date
Change of address
Telephone no.
Key: Institutional PH-Public Health PD-Private Duty O-Other H. N.-Home Nursing V.N.A.-Vol. Nurse's Aide
Indicate major responsibility in Institutional and "Public Health columns according to following key: GS-General Staff
Ad.-Administration
Sup.-Supervision ns.-Instruction Hd. N.-Head Nurse
N
6
0
R
8
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DTO data
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