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Kersey, Ethel
Badge #63,553
ek
RED CROSS BADGE NUMBER
AMERICAN RED CROSS
63,553
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
TELEPHONE NO.
IF MARRIED,
KeRsey GIVE MAIDEN Ethel NAME
HUSBAND'S NAME
PERMANENT ADDRESS (Street, city, zone, county, state)
PRESENT
ADDRESS (Street, 21 1/2 city, West zone, High county, St., state) ElizabethTowN, Pennsyl vania
300 fourth Ave., New YORK 10, Ny.
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
MRS George R. (BedaMay) KeRsey, 21 /2 High St., ElizabethTown, Pa.
MoTheR
DATE OF BIRTH (Month, day, year)
October 21, 1898
Single
yes
Married
Separated
Widowed
Divorced-
WHAT LANGUAGES DO YOU SPEAK?
ENglish
YES
NO
HIGH SCHOOL GRADUATE
X
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
Seorge Teabody College for Teachers, Nashville, Tennessee 9/1-41-4/00-43 BS Sogree Nursing Education
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
REGISTERED?
Pennsylvania and Michigan
NURSES' ASSOCIATION?
PRESENT EMPLOYMENT If not employed check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medic ine surgery, etc.) x
NuRsiNg Field Represen lative, NoRth Atlantic ARea
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
21. CITY AUG 20
STATE
ARC Nursing Nerry
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
good
gVOT 18908
1935
VOLUNTEER SERVICE
no
The
purpose of the following tements is to identify the nurses who can be counted upon to respond to a call
to participate in a Red Cross chapter program Please check the "Yes" box only you are wi lling and able to
serve if called on within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
2
1. Teach home
YES
NO
Attend an instructors' training program, if offered. (Funds are available for
YES
NO
nursing classes
training home nursing instructors. See local chapter.)
2. Serve in case
YES
NO
only in home community
Attend disaster institutes, 1f
YES
NO
of disaster
In other communities
offered, in preparation for service
3. Teach nurse's
YES
NO
4. Accept membership on chapter com-
YES
NO
5. Assist with other chapter
YES
NO
aide classes
mittee should services be needed
programs, as needed
If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that
YES
NO
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE MAJOR REASONS
Full DATE time employee ARC Nursing SeRvice , NoRth SIGNATURE Atlantic ARea
8/17-45
8.2
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS FAITHFULNESS
Educ Kerry TO SERVE AND YOUR
IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
NURSE RECRUITMENT
NATIONAL HEADQUARTERS
COMMITTEE
78504M
FORM 1045 Rev. July 1945
Page data
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- Type
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Document data
- ID
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- Core
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- Type
- document
DTO data
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"ocrText": "Kersey, Ethel\nBadge #63,553\nek\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n63,553\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nIF MARRIED,\nKeRsey GIVE MAIDEN Ethel NAME\nHUSBAND'S NAME\nPERMANENT ADDRESS (Street, city, zone, county, state)\nPRESENT\nADDRESS (Street, 21 1/2 city, West zone, High county, St., state) ElizabethTowN, Pennsyl vania\n300 fourth Ave., New YORK 10, Ny.\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nMRS George R. (BedaMay) KeRsey, 21 /2 High St., ElizabethTown, Pa.\nMoTheR\nDATE OF BIRTH (Month, day, year)\nOctober 21, 1898\nSingle\nyes\nMarried\nSeparated\nWidowed\nDivorced-\nWHAT LANGUAGES DO YOU SPEAK?\nENglish\nYES\nNO\nHIGH SCHOOL GRADUATE\nX\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nSeorge Teabody College for Teachers, Nashville, Tennessee 9/1-41-4/00-43 BS Sogree Nursing Education\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nREGISTERED?\nPennsylvania and Michigan\nNURSES' ASSOCIATION?\nPRESENT EMPLOYMENT If not employed check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medic ine surgery, etc.) x\nNuRsiNg Field Represen lative, NoRth Atlantic ARea\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\n21. CITY AUG 20\nSTATE\nARC Nursing Nerry\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\ngood\ngVOT 18908\n1935\nVOLUNTEER SERVICE\nno\nThe\npurpose of the following tements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program Please check the \"Yes\" box only you are wi lling and able to\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\n2\n1. Teach home\nYES\nNO\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, 1f\nYES\nNO\nof disaster\nIn other communities\noffered, in preparation for service\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\naide classes\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS\nFull DATE time employee ARC Nursing SeRvice , NoRth SIGNATURE Atlantic ARea\n8/17-45\n8.2\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS FAITHFULNESS\nEduc Kerry TO SERVE AND YOUR\nIN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nNURSE RECRUITMENT\nNATIONAL HEADQUARTERS\nCOMMITTEE\n78504M\nFORM 1045 Rev. July 1945"
}