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Form 1045
Rev. Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
Name in full JacobseN Marguerite (first) (middle) K.
Tel. No Eldorado 5-9035
(last)
If married, give maiden name
Year of birth 1896
Marital status SiNgle
Husband's name
(single, married, widowed, divorced)
Permanent address
27 ChestNut St. Girdrd
Eric
Penn
(street)
(city)
(county)
(state)
Probable address
for the next year
400 E 50th St.
Newyork
New york
N.Y.
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
Jacobsen JaNCS C. Brother 27ChestNut St. Girard Penn.
(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)
American Nurses Association, 1790 Broadway, New York N.Y.
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
RAM
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
In what major field was above study? SupervisioN, Public Health Nursing
What languages, other than English, do you speak? Danish (Not fluently)
*Academic year
(OVER)
Page data
- Page
- 81
- Source index
- 0
- Type
- photo
- Media ID
- e4600c91441bfe42
- Size
- unknown
Document data
- ID
- 2661692
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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"month": 9,
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"logicalDate": "1918-06-03",
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"ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName in full JacobseN Marguerite (first) (middle) K.\nTel. No Eldorado 5-9035\n(last)\nIf married, give maiden name\nYear of birth 1896\nMarital status SiNgle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address\n27 ChestNut St. Girdrd\nEric\nPenn\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\n400 E 50th St.\nNewyork\nNew york\nN.Y.\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nJacobsen JaNCS C. Brother 27ChestNut St. Girard Penn.\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)\nAmerican Nurses Association, 1790 Broadway, New York N.Y.\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\nRAM\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\nIn what major field was above study? SupervisioN, Public Health Nursing\nWhat languages, other than English, do you speak? Danish (Not fluently)\n*Academic year\n(OVER)"
}