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I
5
(6
S
Form 1045
M
Rev. Nov. 1941
AMERICAN RED CROSS
1
NURSING SERVICE
Name in full Hines myrtle hellie
Tel. No Frederick 1814-72
(last)
(first)
(middle)
If married, give maiden name
Year of birth 1887
be
Marital status.
Single
Husband's name
(single, married, widowed, divorced)
N
Permanent address Frederick
R.D#4- Maryla nd
(street)
(city)
(county)
(state)
e
Probable address
for the next year
frederick,
P.D.#4
(street)
(city)
(county)
maryland
(state)
Give name and address of nearest relative or friend in United States:
Charles W. Hines. father
same
(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
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)
How many years did you attend HIGH SCHOOL? One
Two
Three
Four
Graduated
Yes
No
SINCE GRADUATION FROM YOUR SCHOOL OF NURSING
have you ever had-
1. A postgraduate course or experience in any of the following special services?
Postgraduate course
Experience in hospital
in a hospital
or public health field
(at least 3 months)
(at least 6 months)
Communicable disease nursing (include Tbc)
Psychiatric Nursing
Operating room
Anaesthesia
Public health nursing
2. Have you taken any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
P.H.D.
Certificate in
* one year
year
years
years
years
degree
degree
degree
Public Health
2
In what major field was above study?
W
What languages, other than English, do you speak?
none
8
(OVER)
6
* Academic year
Page data
- Page
- 17
- Source index
- 0
- Type
- photo
- Media ID
- b67927af855811d8
- Size
- unknown
Document data
- ID
- 2661643
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source metadata
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Document source extras
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"logicalDate": "1918-05-30",
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Page context
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"ocrText": "I\n5\n(6\nS\nForm 1045\nM\nRev. Nov. 1941\nAMERICAN RED CROSS\n1\nNURSING SERVICE\nName in full Hines myrtle hellie\nTel. No Frederick 1814-72\n(last)\n(first)\n(middle)\nIf married, give maiden name\nYear of birth 1887\nbe\nMarital status.\nSingle\nHusband's name\n(single, married, widowed, divorced)\nN\nPermanent address Frederick\nR.D#4- Maryla nd\n(street)\n(city)\n(county)\n(state)\ne\nProbable address\nfor the next year\nfrederick,\nP.D.#4\n(street)\n(city)\n(county)\nmaryland\n(state)\nGive name and address of nearest relative or friend in United States:\nCharles W. Hines. father\nsame\n(name)\n(relationship)\n(address)\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\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)\nHow many years did you attend HIGH SCHOOL? One\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n* one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\n2\nIn what major field was above study?\nW\nWhat languages, other than English, do you speak?\nnone\n8\n(OVER)\n6\n* Academic year"
}