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N
G
ee.
0
a
ITT
eel
M
FORM 1045
REV. OCT. 1943
L
S
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
kaee
R
E
ac
+
5
Red Cross
Badge number 21594
If you have changed your last name
since contacting us, please check here.
eel
Name in full godley (last)
Ethel
Vio la
Tel. No. 1216
(first)
(middle)
If married, give maiden name Race
L
Date of birth 1-1-1885
Marital status widowed.
Husband's name Berton J.
(single, married, widowed, diyorced)
Permanent address Pinellas Clearwater
Pinelias
F7a
C
(street)
(city)
(county)
(state)
"
B
Present address
"
"
"
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
mrs. R.P.Newton, (name) Stan ley. newyork (address)
Luusin
(relationship)
Are you employed in nursing at the present time Yes
No
If employed, check the type of work you are doing and fill in below the title of your position and the name
and address of the agency or institution:
Institutional
Public Health
Industrial
Private Duty
Other
If not employed, what type of nursing would you prefer to render?
IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND
ANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX
AVAILABILITY FOR SERVICE WITH THE ARMED FORCES
Requirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45.
She
may be single or married, but if married she must have no dependents under 14 years of age.
If eligible and not already in service with the armed forces, are you:
Immediately available?
Available in the near future?
(specify date)
Not
available, for the following reason? Ouer age limit
(specify)
Do you have any dependents under 14 years of age? Yes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes?
nou
2
To teach volunteer nurse's aides?
nu
To take a Red Cross emergency assignment? ? inextreme emergency
To serve overseas caring for civilians? 3
-
:
5
Have you ever served with the Red Cross in a disaster? Yes
No
a
If yes, specify type of disaster
-
Page data
- Page
- 19
- Source index
- 0
- Type
- photo
- Media ID
- c131a28a7ea7a7a7
- Size
- unknown
Document data
- ID
- 2661538
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Page context
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"ocrText": "N\nG\nee.\n0\na\nITT\neel\nM\nFORM 1045\nREV. OCT. 1943\nL\nS\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nkaee\nR\nE\nac\n+\n5\nRed Cross\nBadge number 21594\nIf you have changed your last name\nsince contacting us, please check here.\neel\nName in full godley (last)\nEthel\nVio la\nTel. No. 1216\n(first)\n(middle)\nIf married, give maiden name Race\nL\nDate of birth 1-1-1885\nMarital status widowed.\nHusband's name Berton J.\n(single, married, widowed, diyorced)\nPermanent address Pinellas Clearwater\nPinelias\nF7a\nC\n(street)\n(city)\n(county)\n(state)\n\"\nB\nPresent address\n\"\n\"\n\"\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\nmrs. R.P.Newton, (name) Stan ley. newyork (address)\nLuusin\n(relationship)\nAre you employed in nursing at the present time Yes\nNo\nIf employed, check the type of work you are doing and fill in below the title of your position and the name\nand address of the agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nIf not employed, what type of nursing would you prefer to render?\nIT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND\nANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX\nAVAILABILITY FOR SERVICE WITH THE ARMED FORCES\nRequirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45.\nShe\nmay be single or married, but if married she must have no dependents under 14 years of age.\nIf eligible and not already in service with the armed forces, are you:\nImmediately available?\nAvailable in the near future?\n(specify date)\nNot\navailable, for the following reason? Ouer age limit\n(specify)\nDo you have any dependents under 14 years of age? Yes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes?\nnou\n2\nTo teach volunteer nurse's aides?\nnu\nTo take a Red Cross emergency assignment? ? inextreme emergency\nTo serve overseas caring for civilians? 3\n-\n:\n5\nHave you ever served with the Red Cross in a disaster? Yes\nNo\na\nIf yes, specify type of disaster\n-"
}