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Form 1045
AMERICAN RED CROSS
Rev. Nov. 1942
AIT
BITI
zos NURSING SERVICE
no
Menneast Co.
M
If you have changed your last name since
Name in full Johnson
contacting us, please check here
mabel
nelson
Tel. No main 6428
(last)
(first)
(middle)
If married, give maiden name mabei nelson
Date of birth may 25-1891
absel
M
Marital status.
married
Husband's name W. ashton Johnson
(single, married, widowed, divorced)
Permanent address 2011 quilford Road Rockford Winnebago
Illinois
(s)
(street)
Probable
address
(city)
(county)
(state)
for the next year 2011 quilford (street) Road, Rockford Winnebago Illinois
(city)
(county)
(state)
I
M
Give name and address of nearest relative or friend in United States:
Jea
W. ashton Johnson
husband 2011 quilford Road, Rockford, Illinois
beli
a
(name)
-
(relationship)
(address)
Are you employed in nursing at the present time?
Yes
No
S.
5
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
on
(D
-
Institutional
Public health
Industrial
L
Private duty
Other (write in)
Government Service:
Army, Regular
Navy, Regular
Veterans Administration
C
Reserve
Reserve
Children's Bureau
U.S.P.H. Service
U.S. Indian Service
MAJOR RESPONSIBILITIES
Administration
201
Teaching
of present employment
Private duty
Supervision
Jon
General staff
Other (specify)
If not employed, what type of nursing would you prefer to render?
Public
Health
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? none
Did you have a five-year course granting bachelor's degree?
AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-
Postgraduate course
1. A postgraduate course or experience in any of the following services? (at
in a hospital
Experience in hospital
least
3
months)
(at least 6 months)
Communicable disease nursing (include tuberculosis)
Psychiatric nursing
Operating room
nCI
Anaesthesia
2. Have you had any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
Ph.D.
one academic year
M. D.
year
years
years
years
degree
degree
degree
degree
bok
In
what major field was above study? English - Govern ment.
3. Training and experience in the public health field: Postgraduate 4 months or more
Certificate
Degree
Experience-6-monthe-
byears
Have you ever held a position as an air hostess?
Yes
No
How long?
6
Have you ever had any other air experience?
Yes
No
Specify
of
Over sea's service with the American Red Cross in
(OVER)
France and montenegro
10-16-43
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- Type
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Document data
- ID
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- Core
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- Type
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"ocrText": "Form 1045\nAMERICAN RED CROSS\nRev. Nov. 1942\nAIT\nBITI\nzos NURSING SERVICE\nno\nMenneast Co.\nM\nIf you have changed your last name since\nName in full Johnson\ncontacting us, please check here\nmabel\nnelson\nTel. No main 6428\n(last)\n(first)\n(middle)\nIf married, give maiden name mabei nelson\nDate of birth may 25-1891\nabsel\nM\nMarital status.\nmarried\nHusband's name W. ashton Johnson\n(single, married, widowed, divorced)\nPermanent address 2011 quilford Road Rockford Winnebago\nIllinois\n(s)\n(street)\nProbable\naddress\n(city)\n(county)\n(state)\nfor the next year 2011 quilford (street) Road, Rockford Winnebago Illinois\n(city)\n(county)\n(state)\nI\nM\nGive name and address of nearest relative or friend in United States:\nJea\nW. ashton Johnson\nhusband 2011 quilford Road, Rockford, Illinois\nbeli\na\n(name)\n-\n(relationship)\n(address)\nAre you employed in nursing at the present time?\nYes\nNo\nS.\n5\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\non\n(D\n-\nInstitutional\nPublic health\nIndustrial\nL\nPrivate duty\nOther (write in)\nGovernment Service:\nArmy, Regular\nNavy, Regular\nVeterans Administration\nC\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\n201\nTeaching\nof present employment\nPrivate duty\nSupervision\nJon\nGeneral staff\nOther (specify)\nIf not employed, what type of nursing would you prefer to render?\nPublic\nHealth\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? none\nDid you have a five-year course granting bachelor's degree?\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-\nPostgraduate course\n1. A postgraduate course or experience in any of the following services? (at\nin a hospital\nExperience in hospital\nleast\n3\nmonths)\n(at least 6 months)\nCommunicable disease nursing (include tuberculosis)\nPsychiatric nursing\nOperating room\nnCI\nAnaesthesia\n2. Have you had any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\none academic year\nM. D.\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\nbok\nIn\nwhat major field was above study? English - Govern ment.\n3. Training and experience in the public health field: Postgraduate 4 months or more\nCertificate\nDegree\nExperience-6-monthe-\nbyears\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\n6\nHave you ever had any other air experience?\nYes\nNo\nSpecify\nof\nOver sea's service with the American Red Cross in\n(OVER)\nFrance and montenegro\n10-16-43"
}