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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.

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Size
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2661496
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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."
}