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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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    "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."
}