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FORM 1045
REV. JAN 1941
V
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
Name in full grious
Martha allegue Year of Birth
ar
1904
(SURNAME)
(FIRST)
(MIÓDLE)
+
Husband's name
5
Permanent address 223 W. (STREET) South Al (CITY) Penajuille (COUNTY) Perry Missouri (STATE)
a
Probable for the next address year 409 Mardlane Aph 16 Little Rock Pulaski arkonsas
D
(STREET)
(CITY)
(COUNTY)
(STATE)
2-4820
-
Telephone number
(EXCHANGE)
-
(NO.)
Give name and address of nearest relative or friend in United States:
e
grious, Lunette mother 223 tl. South th Penaguille Ms.
1
(NAME)
(RELATIONSHIP)
(ÁDDRESS)
5
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
e
Institutional
Public Health
Private duty
listing Numse Assin of Gi. Little Rock
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? year
Present physical condition Dand
Badge No. 59029
Current date March 6-1941
Name of Committee
ark States Local
e
a
0
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
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- Source index
- 0
- Type
- photo
- Media ID
- 7663ae4ad9d28335
- Size
- unknown
Document data
- ID
- 2661496
- 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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"ocrText": "FORM 1045\nREV. JAN 1941\nV\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nName in full grious\nMartha allegue Year of Birth\nar\n1904\n(SURNAME)\n(FIRST)\n(MIÓDLE)\n+\nHusband's name\n5\nPermanent address 223 W. (STREET) South Al (CITY) Penajuille (COUNTY) Perry Missouri (STATE)\na\nProbable for the next address year 409 Mardlane Aph 16 Little Rock Pulaski arkonsas\nD\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\n2-4820\n-\nTelephone number\n(EXCHANGE)\n-\n(NO.)\nGive name and address of nearest relative or friend in United States:\ne\ngrious, Lunette mother 223 tl. South th Penaguille Ms.\n1\n(NAME)\n(RELATIONSHIP)\n(ÁDDRESS)\n5\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\ne\nInstitutional\nPublic Health\nPrivate duty\nlisting Numse Assin of Gi. Little Rock\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\nyou be interested in teaching classes in Home Hygiene and Care of the Sick? year\nPresent physical condition Dand\nBadge No. 59029\nCurrent date March 6-1941\nName of Committee\nark States Local\ne\na\n0\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."
}