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2nd
R
Form 1045
Rev. Nov. 1942
AMERICAN RED CROSS
NURSING SERVICE
DC ocean park moring
santa
If you have changed your last name since
Name in full Danglus an Harriette Cheld and
contacting us, please check here.
Tel. No. .4-2604
(last)
(first)
(middle)
If married, give maiden name
Date of birth aug. 10.1875
Marital status
Husband's name
(single, married, widowed, divorced)
Permanent address
(street)
(city)
(state)
for the next
address year 722-4. in Ch. Santa manica Calif.
(county)
Probable
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
Harding, (name) alfed (relationship) nephew Harting-am (address) Hundan my
Are you employed in nursing at the present time?
Yes
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
Institutional
Public health
Industrial
Private duty
Other (write in)
Government Service: Army, Regular
Navy, Regular
Veterans Administration
Reserve
Reserve
Children's Bureau
U.S.P.H. Service
U.S. Indian Service
MAJOR RESPONSIBILITIES
Administration
Teaching
Private duty
of present employment
Supervision
General staff
Other (specify)
If not employed, what type of nursing would you prefer to render?
How many years did you attend HIGH SCHOOL?
One
Two
Three
Four
Graduated
Yes
No
Before entering training, how many years did you attend COLLEGE?
Did you have a five-year course granting bachelor's degree?
AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-
ho
Postgraduate course
in a hospital
Experience in hospital
1. A postgraduate course or experience in any of the following services? (at least 3 months)
(at least 6 months)
Communicable disease nursing (include tuberculosis)
Psychiatric nursing
Operating room
Anaesthesia
2. Have you had any courses in a college or university?
ho
Less than
One
Two
Three
Four
Bachelor's
Master's
Ph.D.
M. D.
one academic year
year
years
years
years
degree
degree
degree
degree
In what major field was above study?
3. Training and experience in the public health field: Postgraduate 4 months or more
Certificate
Degree
Experience 6 months
Have you ever held a position as an air hostess?
Yes
No
How long?
Have you ever had any other air experience?
Yes
No
Specify
(OVER)
Page data
- Page
- 33
- Source index
- 0
- Type
- photo
- Media ID
- d6b5664a41a4766c
- Size
- unknown
Document data
- ID
- 2661383
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "2nd\nR\nForm 1045\nRev. Nov. 1942\nAMERICAN RED CROSS\nNURSING SERVICE\nDC ocean park moring\nsanta\nIf you have changed your last name since\nName in full Danglus an Harriette Cheld and\ncontacting us, please check here.\nTel. No. .4-2604\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate of birth aug. 10.1875\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nPermanent address\n(street)\n(city)\n(state)\nfor the next\naddress year 722-4. in Ch. Santa manica Calif.\n(county)\nProbable\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nHarding, (name) alfed (relationship) nephew Harting-am (address) Hundan my\nAre you employed in nursing at the present time?\nYes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nIndustrial\nPrivate duty\nOther (write in)\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral staff\nOther (specify)\nIf not employed, what type of nursing would you prefer to render?\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nBefore entering training, how many years did you attend COLLEGE?\nDid you have a five-year course granting bachelor's degree?\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-\nho\nPostgraduate course\nin a hospital\nExperience in hospital\n1. A postgraduate course or experience in any of the following services? (at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include tuberculosis)\nPsychiatric nursing\nOperating room\nAnaesthesia\n2. Have you had any courses in a college or university?\nho\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\nM. D.\none academic year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\nIn what major field was above study?\n3. Training and experience in the public health field: Postgraduate 4 months or more\nCertificate\nDegree\nExperience 6 months\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\nHave you ever had any other air experience?\nYes\nNo\nSpecify\n(OVER)"
}