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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)

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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)"
}