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FORM 1045
REV. JAN 1041
e
AMERICAN RED CROSS
Focate
s
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
+
in full Foerster , T Alma Emma Year of Birth 1885
e
Name
(SURNAME)
(FIRST)
(MIDDLE)
9
Husband's name none.
Permanent address 5946 East Circle Ave., Chicago,
cook,
Illinois
D
morrood (STREET) Park station,
(CITY)
(COUNTY)
(STATE)
-
Probable address
for the next year 5946 East (STREET) norwood Parkstohon Clucago,
Cook, Illinois
3
5
(CITY)
(COUNTY)
(STATE)
Telephone number Newcastle
1204.
a
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
Mrs (NAME) John Falreyer,
sister, norwood Park Station, Chicago, (ADDRESS) all
5946 East Circleave
(RELATIONSHÍP)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
grivate
Public Health
semporary
Private duty
Metropolitan sife Insurance Company.Clairspo
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
Refief
MAJOR R ESPONSIBILITIES
Adminis
(Temporatory)
Super
Teach-
Gene: ral
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
(only
(WRITE IN)
AVAILABILITY
M.L.I.Co.
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 Very good
Badge 2871.
No.
Current date January 28,1941.
Name of Committee chicago Chapter american RedCross.
Note
: If a nurse does not complete and return this questionnaire, and cannot be located
2
within two years, her enrollment will be removed from our active files.
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- Source index
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- Type
- photo
- Media ID
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Document data
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- Core
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"ocrText": "F\n0\nFORM 1045\nREV. JAN 1041\ne\nAMERICAN RED CROSS\nFocate\ns\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\n+\nin full Foerster , T Alma Emma Year of Birth 1885\ne\nName\n(SURNAME)\n(FIRST)\n(MIDDLE)\n9\nHusband's name none.\nPermanent address 5946 East Circle Ave., Chicago,\ncook,\nIllinois\nD\nmorrood (STREET) Park station,\n(CITY)\n(COUNTY)\n(STATE)\n-\nProbable address\nfor the next year 5946 East (STREET) norwood Parkstohon Clucago,\nCook, Illinois\n3\n5\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number Newcastle\n1204.\na\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nMrs (NAME) John Falreyer,\nsister, norwood Park Station, Chicago, (ADDRESS) all\n5946 East Circleave\n(RELATIONSHÍP)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\ngrivate\nPublic Health\nsemporary\nPrivate duty\nMetropolitan sife Insurance Company.Clairspo\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nRefief\nMAJOR R ESPONSIBILITIES\nAdminis\n(Temporatory)\nSuper\nTeach-\nGene: ral\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(only\n(WRITE IN)\nAVAILABILITY\nM.L.I.Co.\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 Very good\nBadge 2871.\nNo.\nCurrent date January 28,1941.\nName of Committee chicago Chapter american RedCross.\nNote\n: If a nurse does not complete and return this questionnaire, and cannot be located\n2\nwithin two years, her enrollment will be removed from our active files."
}