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2nd P.H.R.
Form 1045
AMERICAN RED CROSS
D.e,
Rev. Nov. 1942
NURSING SERVICE
Indianapilis
If you have changed your last name since
Name in full Gaskill Ina
contacting us, please check here.
m
Tel. No Hn 7934
(last)
(first)
(middle)
If married, give maiden name
Date of birth He22,1884
Marital status
single
Husband's name
(single, married, widowed, divorced)
Permanent
address
623 East 53 st Indianap this Indiana
(street)
(city)
(county)
(state)
Probable address
for the next year
same
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
Many a. Meyers
friend
as
above
(name)
(relationship)
(address)
Are you employed in nursing at the present time?
Yes
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
Institutional
Public health
High School
Shortridge
Indianapolic
Ind
Industrial
Private duty
Other (write in)
Government Service: Army, Regular
Navy, Regular
Veterans Administration
Reserve
Reserve
Children's Bureau
U.S.P.H. Service
U.S. Indian Service
MAJOR RESPONSIBILITIES
Administration
Teaching
Private duty
of present employment
Supervision
General staff
Other (specify)
If not employed, what type of nursing would you prefer to render?
How many years did you attend HIGH SCHOOL?
One
Two
Three
Four
Graduated
Yes
No
Before entering training, how many years did you attend COLLEGE? have
Did you have a five-year course granting bachelor's degree?
AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-
Postgraduate course
in a hospital
Experience in hospital
1. A postgraduate course or experience in any of the following services? (at least 3 months)
(at least 6 months)
Communicable disease nursing (include tuberculosis)
no
Psychiatric nursing
Operating room
Anaesthesia
2. Have you had any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
Ph.D.
M. D.
one academic year
year
years
years
years
degree
degree
degree
degree
In what major field was above study?
Public
Health,
Education
3.
Training
and
experience
in
the
public
health
field:
Postgraduate
4
months
or
more
Certificate
Degree
Experience 6 months
Have you ever held a position as an air hostess?
Yes
No
How long?
Have you ever had any other air experience?
Yes
No
Specify
8/20
(OVER)
Page data
- Page
- 16
- Source index
- 0
- Type
- photo
- Media ID
- 222d0c7dbff51518
- Size
- unknown
Document data
- ID
- 2661518
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
Document identity
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"logicalDate": "1911-03-10",
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Page context
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"ocrText": "2nd P.H.R.\nForm 1045\nAMERICAN RED CROSS\nD.e,\nRev. Nov. 1942\nNURSING SERVICE\nIndianapilis\nIf you have changed your last name since\nName in full Gaskill Ina\ncontacting us, please check here.\nm\nTel. No Hn 7934\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate of birth He22,1884\nMarital status\nsingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent\naddress\n623 East 53 st Indianap this Indiana\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\nsame\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nMany a. Meyers\nfriend\nas\nabove\n(name)\n(relationship)\n(address)\nAre you employed in nursing at the present time?\nYes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nHigh School\nShortridge\nIndianapolic\nInd\nIndustrial\nPrivate duty\nOther (write in)\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral staff\nOther (specify)\nIf not employed, what type of nursing would you prefer to render?\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nBefore entering training, how many years did you attend COLLEGE? have\nDid you have a five-year course granting bachelor's degree?\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-\nPostgraduate course\nin a hospital\nExperience in hospital\n1. A postgraduate course or experience in any of the following services? (at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include tuberculosis)\nno\nPsychiatric nursing\nOperating room\nAnaesthesia\n2. Have you had any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\nM. D.\none academic year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\nIn what major field was above study?\nPublic\nHealth,\nEducation\n3.\nTraining\nand\nexperience\nin\nthe\npublic\nhealth\nfield:\nPostgraduate\n4\nmonths\nor\nmore\nCertificate\nDegree\nExperience 6 months\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\nHave you ever had any other air experience?\nYes\nNo\nSpecify\n8/20\n(OVER)"
}