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FORM 1045
5
REV. JAN 1941
in
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
Name in full Enand
Phyllis
Lou
I
Year of Birth 1917
(SURNAME)
(FIRST)
(MIDDLE)
M
1/1
Husband's name
mass.
S
Permanent address marafald, 37 Everett middleser
(STATE)
use
Ilis
(STREET)
(CITY)
(COUNTY)
de
Probable address
for the next year
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
(EXCHANGE)
(NO.)
Mr
u
Give name and address of nearest relative or friend in United States:
a
mra yes. H.
moster
same
55
(RELATIONSHIP)
(ADDRESS)
(NAME)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
Public Health
Private duty
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
At the present time would you
Date
accept assignment to the Army? Yes
No
Navy? Yes
No
available
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
8
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
Present physical condition
Badge
No. 81420
Current
date 1-28-41
Name of Committee
middleser Essay, mass.
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.
Page data
- Page
- 86
- Source index
- 0
- Type
- photo
- Media ID
- 4314f7519b9c604e
- Size
- unknown
Document data
- ID
- 2661441
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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Page context
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"ocrText": "3\nFORM 1045\n5\nREV. JAN 1941\nin\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\nName in full Enand\nPhyllis\nLou\nI\nYear of Birth 1917\n(SURNAME)\n(FIRST)\n(MIDDLE)\nM\n1/1\nHusband's name\nmass.\nS\nPermanent address marafald, 37 Everett middleser\n(STATE)\nuse\nIlis\n(STREET)\n(CITY)\n(COUNTY)\nde\nProbable address\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\n(EXCHANGE)\n(NO.)\nMr\nu\nGive name and address of nearest relative or friend in United States:\na\nmra yes. H.\nmoster\nsame\n55\n(RELATIONSHIP)\n(ADDRESS)\n(NAME)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nPublic Health\nPrivate duty\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\ntration\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\nAt the present time would you\nDate\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable\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\n8\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nPresent physical condition\nBadge\nNo. 81420\nCurrent\ndate 1-28-41\nName of Committee\nmiddleser Essay, mass.\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."
}