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2nd
Form 1045
Rev. Nov. 1942
ama exorraso
AMERICAN RED CROSS
zoa
NURSING SERVICE
Does clester Co,
If you have changed your last name since
contacting us, please check here
Name
in full Joaquim Lucy Louisa
Tel. No. Bedford vill 7!4!
(last)
(first)
(middle)
-1585
If married, give maiden name.
Date of birth over 40.
Marital status
Husband's name
(single married, widowed, divorced)
Permanent address
corner R Bedford Westchester
(street)
(city
(county)
n.y
state)
Probable address
for the next year
or
"
"
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
Amelia Joaquin name)
sister
same as above
(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
Westchester Co. Dept. of Health.
Industrial
bluow
Private duty
oi sidalieva
Other (write in)
oidalisva vistaibemme
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)
If not employed, what type of nursing would you prefer to render?
How many years did you attend HIGH SCHOOL?
One
Two
Three
Four
Graduated
X
Yes
No
Before entering training, how many years did you attend COLLEGE? O
Did you have a five-year course granting bachelor's degree?
AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-
Postgraduate course
in a hospital
Experience in hospital
1. A postgraduate course or experience in any of the following services? (at least
3
months)
(at least 6 months)
Communicable disease nursing (include tuberculosis)
Psychiatric nursing
Operating room
Anaesthesia
2. Have you had any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
Ph.D
M. D.
one academic year
year
years
years
years
degree
degree
degree
degree
In what major field was above study? Public Health nursing
3. Training and experience in the public health field: Postgraduate 4 months or more
with
Certificate
I
Degree
Experience 6 months
Have you ever held a position as an air hostess?
Yes
No
How long?
5
Have you ever had any other air experience?
Yes
No
Specify
I
(OVER)
N
Page data
- Page
- 16
- Source index
- 0
- Type
- photo
- Media ID
- c4eb57fa86bc86cf
- Size
- unknown
Document data
- ID
- 2661703
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Page context
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"ocrText": "2nd\nForm 1045\nRev. Nov. 1942\nama exorraso\nAMERICAN RED CROSS\nzoa\nNURSING SERVICE\nDoes clester Co,\nIf you have changed your last name since\ncontacting us, please check here\nName\nin full Joaquim Lucy Louisa\nTel. No. Bedford vill 7!4!\n(last)\n(first)\n(middle)\n-1585\nIf married, give maiden name.\nDate of birth over 40.\nMarital status\nHusband's name\n(single married, widowed, divorced)\nPermanent address\ncorner R Bedford Westchester\n(street)\n(city\n(county)\nn.y\nstate)\nProbable address\nfor the next year\nor\n\"\n\"\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nAmelia Joaquin name)\nsister\nsame as above\n(relationship)\n)\n(address)\nAre you employed in nursing at the present time?\nYes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nWestchester Co. Dept. of Health.\nIndustrial\nbluow\nPrivate duty\noi sidalieva\nOther (write in)\noidalisva vistaibemme\nGovernment Service:\nArmy, 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)\nIf not employed, what type of nursing would you prefer to render?\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nX\nYes\nNo\nBefore entering training, how many years did you attend COLLEGE? O\nDid you have a five-year course granting bachelor's degree?\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-\nPostgraduate course\nin a hospital\nExperience in hospital\n1. A postgraduate course or experience in any of the following services? (at least\n3\nmonths)\n(at least 6 months)\nCommunicable disease nursing (include tuberculosis)\nPsychiatric nursing\nOperating room\nAnaesthesia\n2. Have you had any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D\nM. D.\none academic year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\nIn what major field was above study? Public Health nursing\n3. Training and experience in the public health field: Postgraduate 4 months or more\nwith\nCertificate\nI\nDegree\nExperience 6 months\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\n5\nHave you ever had any other air experience?\nYes\nNo\nSpecify\nI\n(OVER)\nN"
}