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DEL 151943
FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
M.
ANNUAL QUESTIONNAIRE-1944
If you have changed your last name
Red Cross
Badge number 14217
since contacting us, please check here.
Name in full Heilman
Charlotte
M.
Tel. No. Bound Brook NJ
(last)
(first)
(middle)
18765.
If married, give maiden name Charlotte Miller
Date of birth 1880-Nov.25.
Marital status
widowed
Husband's name
Charles. J. Heitona
(single, married, widowed, divorced)
Permanent
address 336J. King George (city) Rd- Bound (county) Brook Somerset (state) Co. N. Jersey
(street)
Present address the
same
(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:
Mr. Will 13. Miller 1703 Virginia Ave. East-
Brother
(name)
(address)
Charleston WVa, (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
Red Cross Nursing Consultant - No Allan tic Area
300 4th an nycty 10.
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 ? Over 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:
Not available
To teach Red Cross Home Nursing classes?
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
To serve overseas caring for civilians?
If yes, specify type of disaster. - Refugee Flood Drought Hurricane Eprdenic
Have you ever served with the Red Cross in a disaster? Yes
No
Page data
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- Source index
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- Type
- photo
- Media ID
- 72795d594e68731e
- Size
- unknown
Document data
- ID
- 2661623
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "I\nel\nDEL 151943\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nM.\nANNUAL QUESTIONNAIRE-1944\nIf you have changed your last name\nRed Cross\nBadge number 14217\nsince contacting us, please check here.\nName in full Heilman\nCharlotte\nM.\nTel. No. Bound Brook NJ\n(last)\n(first)\n(middle)\n18765.\nIf married, give maiden name Charlotte Miller\nDate of birth 1880-Nov.25.\nMarital status\nwidowed\nHusband's name\nCharles. J. Heitona\n(single, married, widowed, divorced)\nPermanent\naddress 336J. King George (city) Rd- Bound (county) Brook Somerset (state) Co. N. Jersey\n(street)\nPresent address the\nsame\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:\nMr. Will 13. Miller 1703 Virginia Ave. East-\nBrother\n(name)\n(address)\nCharleston WVa, (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\nRed Cross Nursing Consultant - No Allan tic Area\n300 4th an nycty 10.\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. She\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 available, for the following reason ? Over 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:\nNot available\nTo teach Red Cross Home Nursing classes?\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\nTo serve overseas caring for civilians?\nIf yes, specify type of disaster. - Refugee Flood Drought Hurricane Eprdenic\nHave you ever served with the Red Cross in a disaster? Yes\nNo"
}