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N
Jon
detail
The
n
s
FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
l'agno
NURSING SERVICE
ANNUAL QUESTIONNAIRE-194
closed
M
asY
"to?
adnementup
Red Cross
If
Badge number 11,694
you have changed your last name
<s
1
since contacting us, please check here.
Name in full Johnson mabel
nelson
Tel. No. m6428
(last)
(first)
(middle)
If married, give maiden name mabel U nelson
Date of birth
1891
Marital status married
Nel
M
Husband's name Astiton Johnson
a
(single, married, widowed, divorced)
Permanent
address 2011 Quilford Road Rockford Winnebago I Illinois
5
(street)
(city)
(county)
(state)
Illinois
son
(b
Present address 2011 quilford Road Rockford Winnebago
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
11
Give name and address of nearest relative or friend in the United States:
L
Astron Johnson
2011 quilfo Road
Husband
(name)
(address)
(relationship)
Are you employed in nursing at the present time? Yes
No
If employed, check the type of work you are doing and fill in below the title of your position and the name
C
and address of the agency or institution:
Institutional
Public Health
Industrial
Private Duty
Other
If not employed, what type of nursing would you prefer to render ? Public Health
IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND
ANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX
AVAILABILITY FOR SERVICE WITH THE ARMED FORCES
Requirements:
For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She
may be single or married, but if married she must have no dependents under 14 years of age.
If eligible and not already in service with the armed forces, are you :
Immediately available?
Available in the near future?
(specify date)
Not available, for the following reason ?
(specify)
Do you have any dependents under 14 years of age? Yes
No
wom
AVAILABILITY FOR SERVICE WITH CIVILIANS
UO
If qualified and not already doing so, will you be available:
A
BA
GULIAV
auoy
To teach Red Cross Home Nursing classes? yes
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
of
To serve overseas caring for civilians?
6
Have you ever served with the Red Cross in a disaster? Yes
No
yes, specify type of disaster Red Cross Service in montenegro 1919
of
If
Service in France 1918 Euacuation #3
4
(otata)
Disaster Relief Rockford
Page data
- Page
- 9
- Source index
- 0
- Type
- photo
- Media ID
- da71dca69a5b4b21
- Size
- unknown
Document data
- ID
- 2661711
- 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": "N\nJon\ndetail\nThe\nn\ns\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nl'agno\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-194\nclosed\nM\nasY\n\"to?\nadnementup\nRed Cross\nIf\nBadge number 11,694\nyou have changed your last name\n<s\n1\nsince contacting us, please check here.\nName in full Johnson mabel\nnelson\nTel. No. m6428\n(last)\n(first)\n(middle)\nIf married, give maiden name mabel U nelson\nDate of birth\n1891\nMarital status married\nNel\nM\nHusband's name Astiton Johnson\na\n(single, married, widowed, divorced)\nPermanent\naddress 2011 Quilford Road Rockford Winnebago I Illinois\n5\n(street)\n(city)\n(county)\n(state)\nIllinois\nson\n(b\nPresent address 2011 quilford Road Rockford Winnebago\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\n11\nGive name and address of nearest relative or friend in the United States:\nL\nAstron Johnson\n2011 quilfo Road\nHusband\n(name)\n(address)\n(relationship)\nAre you employed in nursing at the present time? Yes\nNo\nIf employed, check the type of work you are doing and fill in below the title of your position and the name\nC\nand address of the agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nIf not employed, what type of nursing would you prefer to render ? Public Health\nIT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND\nANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX\nAVAILABILITY FOR SERVICE WITH THE ARMED FORCES\nRequirements:\nFor assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She\nmay be single or married, but if married she must have no dependents under 14 years of age.\nIf eligible and not already in service with the armed forces, are you :\nImmediately available?\nAvailable in the near future?\n(specify date)\nNot available, for the following reason ?\n(specify)\nDo you have any dependents under 14 years of age? Yes\nNo\nwom\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nUO\nIf qualified and not already doing so, will you be available:\nA\nBA\nGULIAV\nauoy\nTo teach Red Cross Home Nursing classes? yes\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\nof\nTo serve overseas caring for civilians?\n6\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nyes, specify type of disaster Red Cross Service in montenegro 1919\nof\nIf\nService in France 1918 Euacuation #3\n4\n(otata)\nDisaster Relief Rockford"
}