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FORM 1045
REV. JAN 1041
2
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
Name in full Fitz g gerald (SURNAME) alice (FIRST) Lauise Florence (MIDDLE)
Year of Birth
1874
Husband's name
Permanent address 353 West 57th Street (CITY) new york (COUNTY) uy
(STREET)
(STATE)
Probable address
for the next year same
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number Columbus 5. 6100
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
M. B. Fitzgerald
sisTer in law
390 wadsworth Avenue nyc
(NAME)
(RELATIONSHIP)
(ADDRESS)
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
Would you be interested in teaching classes in Home Hygiene and Care of the Sick? yes
Present physical condition Exceplent.
Badge No. 3748
Current date February 2-41
Name of Committee MANHATTAN
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.
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- Core
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"ocrText": "+\nFORM 1045\nREV. JAN 1041\n2\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nName in full Fitz g gerald (SURNAME) alice (FIRST) Lauise Florence (MIDDLE)\nYear of Birth\n1874\nHusband's name\nPermanent address 353 West 57th Street (CITY) new york (COUNTY) uy\n(STREET)\n(STATE)\nProbable address\nfor the next year same\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number Columbus 5. 6100\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nM. B. Fitzgerald\nsisTer in law\n390 wadsworth Avenue nyc\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\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 tration\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\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick? yes\nPresent physical condition Exceplent.\nBadge No. 3748\nCurrent date February 2-41\nName of Committee MANHATTAN\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."
}