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Form 1045
nashville Gorden Co.
Rev. Nov. 1942
AMERICAN RED CROSS
NURSING SERVICE
If
you have changed your last name since
contacting us, please check here
Name in full
Kersey
Ethel
Tel. No.
(last)
(first)
(middle)
If married, give maiden
Date of birth 1900
Marital status
single
Husband's name
(single, married, widowed, divorced)
Permanent address Box#255 (street) Febbally College (city) Nashville (county)
lennessee
(state)
Probable address
for
the
next year Peabody College
Nashville
Tennessee
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
MRS
Beda
May
KeRsey
Mother
(name)
(relationship)
21 1/2 West High St., Elizabethtown, Pa
(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
Industrial
Private duty
Other (write in)
student Peabody College
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
prefer
to
render?
Public
Health
How
many
years
did
you
attend
HIGH
SCHOOL?
One
Two
Three
Four
Graduated
Yes
No
Before
entering
how
many
years
did
you
attend
COLLEGE?
Did
you
have
a
five-year
bachelor's
degree?
No
AFTER
GRADUATION
FROM
YOUR
SCHOOL
OF
NURSING,
did
you
have-
Postgraduate course
in a hospital
Experience
in
1. A postgraduate course or experience in any of the following services? (at least 3 months)
hospital
(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
field
was
above
study?
Nursing
Education
P.H.N.
3.
Training
experience
in
the
public
health
field:
Postgraduate
4
months
or
more
Certificate
Degree
1943
Experience 6 months
Have you ever held a position as an air hostess?
Yes
No
How long?
Have you ever had any other air experience?
Yes
No
Specify
(OVER)
Page data
- Page
- 21
- Source index
- 0
- Type
- photo
- Media ID
- 57765a33f03d99c2
- Size
- unknown
Document data
- ID
- 2661748
- Core
- doc
- Type
- document
DTO data
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"ocrText": "Form 1045\nnashville Gorden Co.\nRev. Nov. 1942\nAMERICAN RED CROSS\nNURSING SERVICE\nIf\nyou have changed your last name since\ncontacting us, please check here\nName in full\nKersey\nEthel\nTel. No.\n(last)\n(first)\n(middle)\nIf married, give maiden\nDate of birth 1900\nMarital status\nsingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address Box#255 (street) Febbally College (city) Nashville (county)\nlennessee\n(state)\nProbable address\nfor\nthe\nnext year Peabody College\nNashville\nTennessee\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nMRS\nBeda\nMay\nKeRsey\nMother\n(name)\n(relationship)\n21 1/2 West High St., Elizabethtown, Pa\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\nIndustrial\nPrivate duty\nOther (write in)\nstudent Peabody College\nGovernment Service:\nArmy, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S.\nIndian\nService\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate\nduty\nof present employment\nSupervision\nGeneral\nstaff\nOther (specify)\nIf\nnot\nemployed,\nwhat\ntype\nof\nnursing\nprefer\nto\nrender?\nPublic\nHealth\nHow\nmany\nyears\ndid\nyou\nattend\nHIGH\nSCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nBefore\nentering\nhow\nmany\nyears\ndid\nyou\nattend\nCOLLEGE?\nDid\nyou\nhave\na\nfive-year\nbachelor's\ndegree?\nNo\nAFTER\nGRADUATION\nFROM\nYOUR\nSCHOOL\nOF\nNURSING,\ndid\nyou\nhave-\nPostgraduate course\nin a hospital\nExperience\nin\n1. A postgraduate course or experience in any of the following services? (at least 3 months)\nhospital\n(at\nleast\n6\nmonths)\nCommunicable disease nursing (include tuberculosis)\nPsychiatric nursing\nOperating room\nAnaesthesia\n2.\nHave\nyou\nhad\nany\ncourses\nin\na\ncollege\nor\nuniversity?\nLess\nthan\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\nM. D.\none\nacademic\nyear\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\nIn\nwhat\nfield\nwas\nabove\nstudy?\nNursing\nEducation\nP.H.N.\n3.\nTraining\nexperience\nin\nthe\npublic\nhealth\nfield:\nPostgraduate\n4\nmonths\nor\nmore\nCertificate\nDegree\n1943\nExperience 6 months\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\nHave you ever had any other air experience?\nYes\nNo\nSpecify\n(OVER)"
}