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FORM 1048
L
REV. JAR 1041
-
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
JAN 31 1941
WASHINGTON, D. c.
Name in
Heath, full ,
Virginia
gentrude Year of Birth 1904
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
-
Permanent address 201 (STREET) Camington Street, (CITY) Maupeen, Dodge , Visconsin
(COUNTY)
(STATE)
Probable address
for the next year
267 So. Ocean Ave. Treepant nassaw
new York
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
7r. 1869
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
The (NAME) Elmer Heath - father KRELATIONSHIP) - 201 Carington Street, u aspeen, Wis.
E
(ADDRESS)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
lo
Institutional x
Fresport Hospital.
Public Health
Private duty
a
\
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?
Present physical condition Good-
78265
MARIE H. BRUNJES
Badge No.
SECRETARY, LOCAL COMMITTEE
RED CROSS NURSING SERVICE
Current date
4-1-71
Name of Committee
66 COURT STREET
BROOKLYN;
C
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.
5
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Document data
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"ocrText": "I\ne\na\n+\n5.\nFORM 1048\nL\nREV. JAR 1041\n-\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nJAN 31 1941\nWASHINGTON, D. c.\nName in\nHeath, full ,\nVirginia\ngentrude Year of Birth 1904\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\n-\nPermanent address 201 (STREET) Camington Street, (CITY) Maupeen, Dodge , Visconsin\n(COUNTY)\n(STATE)\nProbable address\nfor the next year\n267 So. Ocean Ave. Treepant nassaw\nnew York\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\n7r. 1869\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nThe (NAME) Elmer Heath - father KRELATIONSHIP) - 201 Carington Street, u aspeen, Wis.\nE\n(ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nlo\nInstitutional x\nFresport Hospital.\nPublic Health\nPrivate duty\na\n\\\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\ntration\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 you be interested in teaching classes in Home Hygiene and Care of the Sick?\nPresent physical condition Good-\n78265\nMARIE H. BRUNJES\nBadge No.\nSECRETARY, LOCAL COMMITTEE\nRED CROSS NURSING SERVICE\nCurrent date\n4-1-71\nName of Committee\n66 COURT STREET\nBROOKLYN;\nC\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.\n5"
}