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FORM 1045
AMERICAN RED CROSS
REV. OCT. 1943
NURSING SERVICE
TS
ANNUAL QUESTIONNAIRE-1944
D
Red Cross number 45438
If you have changed your last name
E
since contacting us, please check here.
Name Badge in full Hooley (last) Edich (first) Pattern (middle)
7
a
Tel. No. 66043
e
If married, give maiden name arletha Pallen Date of birth Dec. 28,1891
+
+
Marital status married
(single, married, widowed, divorced)
Husband's name John Q. Hooley
than
Permanent address 5635 (street) Rippey, littsburgh (city) (county) allegling (state)
Present address 1742 nurancy, Honolulic Calu J.H.
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
a
C
Mr. name (name) John Arrowly or friend 5635 (address) in the kippey United States: All (relationship) Pa Heartead
Give and address of mearest relative
Belay
I
J.
Are you employed in nursing at the present time? Yes
No
en
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
general staff musing Hacred Heart Energying Hopes.
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 ? With Red Cross Unit (specify) altocred Heart Every
Do you have any dependents under 14 years of age? Yes
No
Hospital
O.C.'s
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be 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?
Have you ever served with the Red Cross in a disaster? Yes
No
/ near Called)
If yes, specify type of disaster
Page data
- Page
- 24
- Source index
- 0
- Type
- photo
- Media ID
- fd65373a2426088c
- Size
- unknown
Document data
- ID
- 2661661
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"coverageEndDate": {
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"logicalDate": "1944-07-15",
"month": 7,
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"logicalDate": "1927-11-22",
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Page context
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"ocrText": "I\nI\n0\neve.\n0\nto\nx\n'Eal:\nM\nFORM 1045\nAMERICAN RED CROSS\nREV. OCT. 1943\nNURSING SERVICE\nTS\nANNUAL QUESTIONNAIRE-1944\nD\nRed Cross number 45438\nIf you have changed your last name\nE\nsince contacting us, please check here.\nName Badge in full Hooley (last) Edich (first) Pattern (middle)\n7\na\nTel. No. 66043\ne\nIf married, give maiden name arletha Pallen Date of birth Dec. 28,1891\n+\n+\nMarital status married\n(single, married, widowed, divorced)\nHusband's name John Q. Hooley\nthan\nPermanent address 5635 (street) Rippey, littsburgh (city) (county) allegling (state)\nPresent address 1742 nurancy, Honolulic Calu J.H.\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\na\nC\nMr. name (name) John Arrowly or friend 5635 (address) in the kippey United States: All (relationship) Pa Heartead\nGive and address of mearest relative\nBelay\nI\nJ.\nAre you employed in nursing at the present time? Yes\nNo\nen\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\ngeneral staff musing Hacred Heart Energying Hopes.\nIf not employed, what type of nursing would you prefer to render?\nIT\nIS 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:\nFor 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 ? With Red Cross Unit (specify) altocred Heart Every\nDo you have any dependents under 14 years of age? Yes\nNo\nHospital\nO.C.'s\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be 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?\nHave you ever served with the Red Cross in a disaster? Yes\nNo\n/ near Called)\nIf yes, specify type of disaster"
}