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Form 1045
which
Rev. Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
Name
in full Joaquism (last) Lucy (first
Louise
Tel. No. Bedford Village 1141
(middle)
If married, give maiden name
Year of birth. 1883
Marital status
(single, ma rried, widowed, divorced)
single
Husband's name
Permanent address
Corner Road. Bedford Westchester
new york
(street)
(city)
(county)
(stat
Probable address
for the next year
Same as above
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
Amelia (name) J. Joaquim Side (relationship)
Corner Rd Bedford. new york
(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
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
X
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
In what major field was above study? Public Health nursing
5
I
What languages, other than English, do you speak? French
N
Academic year
(OVER)
Page data
- Page
- 18
- Source index
- 0
- Type
- photo
- Media ID
- 6ac4488b9d8185b5
- Size
- unknown
Document data
- ID
- 2661703
- 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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Page context
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"ocrText": "Form 1045\nwhich\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName\nin full Joaquism (last) Lucy (first\nLouise\nTel. No. Bedford Village 1141\n(middle)\nIf married, give maiden name\nYear of birth. 1883\nMarital status\n(single, ma rried, widowed, divorced)\nsingle\nHusband's name\nPermanent address\nCorner Road. Bedford Westchester\nnew york\n(street)\n(city)\n(county)\n(stat\nProbable address\nfor the next year\nSame as above\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nAmelia (name) J. Joaquim Side (relationship)\nCorner Rd Bedford. new york\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\nWestchester Co. Dept. of 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\nX\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\none year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nIn what major field was above study? Public Health nursing\n5\nI\nWhat languages, other than English, do you speak? French\nN\nAcademic year\n(OVER)"
}