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ar
a
L
a
1
Confidential
D
FORM 1219
Please return
REV.JUNE 1942
-
AMERICAN RED CROSS
APPLICATION FOR EMPLOYMENT - NURSING PERSONNEL
L
I. PERSONAL
Name in full Miss Laverna Fish Harvard
Badge (No. 38820
a
(H.D.
(MISS OR MRS.
(IF MARRIED, GIVE MAIDEN NAME ALSO)
Not enrolled
L
Present address N.C.State (STREET) College Informary (CITY) Raleigh (STATE) n.c. Tel. No 7615
2
Permanent address 204 Church St. Hublin 9a.
Tel. No.
a
(STREET)
(CITY)
(STATE)
Citizenship American
Color White Place of birth Laurens Co. ga.
5
$
Present position Head nurse- (TITLE) permo 25.00+ (SALARY) Maintenanciete of birth teb.19 1894
M.C State (ORGANIZATION) College Infirmary
Raleigh (ADDRESS) n.c.
Single
Widowed
F
Married
Divorced
-
S
II. PROFESSIONAL STATUS
5
States registered D.C.Ky Georgia Current registration Georgia of NorthCarolina
To what professional organizations do you belong? Leedmont Hillinnids. Sixth
Mistrict of N.C. no State. and american nurses Association
If not an enrolled Red Cross nurse, has your application for enrollment been submitted to
your Local Committee Red Cross Nursing Service? (NOT chapter committee)
When and to whom?
III. EDUCATION
1. Prior to entering school of nursing:
Name.
City and State Dates Diploma-Degree Major.
High School Mublin H.gh School Hublin aa may 1911 Hiploma - sciences
Normal School Ga State Collage for Women Milledgevers aa may 1913 Capluma Home
Ec.
University rice state College Raleigh n.cl Feb-1938 6 CollegeCr. Socrology
Other
2. School of nursing from) Predmont (NAME) Hospital (CITY) #+lant# (STATE) Ga
which you graduated)
Length of course
5 years
3 years
(Specify other)
Date completed Oct. 1920
3. Undergraduate affiliations:
Hospital or Organization
City and State
Clinical Specialty No. Months
(1)
(2)
(3)
4. Postgraduate clinical courses: (Do not include academic work or employment.)
Hospital or Organization
city and State
Clinical Specialty
Dates
(1) (2) n.y. Hospital
.Y.G.
ibbstetrics
1936.
(3)
5. Academic study since graduation from school of nursing:
College or University
City and State
Academic years
No. Points
(1) N.C. State College
Baleign n.c.
g Semestes.
Cr.
(2)
(3)

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ID: 2661600
Core: doc
Type: document

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    "ocrText": "I\nar\na\nL\na\n1\nConfidential\nD\nFORM 1219\nPlease return\nREV.JUNE 1942\n-\nAMERICAN RED CROSS\nAPPLICATION FOR EMPLOYMENT - NURSING PERSONNEL\nL\nI. PERSONAL\nName in full Miss Laverna Fish Harvard\nBadge (No. 38820\na\n(H.D.\n(MISS OR MRS.\n(IF MARRIED, GIVE MAIDEN NAME ALSO)\nNot enrolled\nL\nPresent address N.C.State (STREET) College Informary (CITY) Raleigh (STATE) n.c. Tel. No 7615\n2\nPermanent address 204 Church St. Hublin 9a.\nTel. No.\na\n(STREET)\n(CITY)\n(STATE)\nCitizenship American\nColor White Place of birth Laurens Co. ga.\n5\n$\nPresent position Head nurse- (TITLE) permo 25.00+ (SALARY) Maintenanciete of birth teb.19 1894\nM.C State (ORGANIZATION) College Infirmary\nRaleigh (ADDRESS) n.c.\nSingle\nWidowed\nF\nMarried\nDivorced\n-\nS\nII. PROFESSIONAL STATUS\n5\nStates registered D.C.Ky Georgia Current registration Georgia of NorthCarolina\nTo what professional organizations do you belong? Leedmont Hillinnids. Sixth\nMistrict of N.C. no State. and american nurses Association\nIf not an enrolled Red Cross nurse, has your application for enrollment been submitted to\nyour Local Committee Red Cross Nursing Service? (NOT chapter committee)\nWhen and to whom?\nIII. EDUCATION\n1. Prior to entering school of nursing:\nName.\nCity and State Dates Diploma-Degree Major.\nHigh School Mublin H.gh School Hublin aa may 1911 Hiploma - sciences\nNormal School Ga State Collage for Women Milledgevers aa may 1913 Capluma Home\nEc.\nUniversity rice state College Raleigh n.cl Feb-1938 6 CollegeCr. Socrology\nOther\n2. School of nursing from) Predmont (NAME) Hospital (CITY) #+lant# (STATE) Ga\nwhich you graduated)\nLength of course\n5 years\n3 years\n(Specify other)\nDate completed Oct. 1920\n3. Undergraduate affiliations:\nHospital or Organization\nCity and State\nClinical Specialty No. Months\n(1)\n(2)\n(3)\n4. Postgraduate clinical courses: (Do not include academic work or employment.)\nHospital or Organization\ncity and State\nClinical Specialty\nDates\n(1) (2) n.y. Hospital\n.Y.G.\nibbstetrics\n1936.\n(3)\n5. Academic study since graduation from school of nursing:\nCollege or University\nCity and State\nAcademic years\nNo. Points\n(1) N.C. State College\nBaleign n.c.\ng Semestes.\nCr.\n(2)\n(3)"
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