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Form 1045
Rev. Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
Name in full Keyes (last
Harriet
(first)
(middle
Kift
Tel. No. Pittenbouse 1515
If
married,
give
maiden name Harriet charlton Kift
Year of birth 1892
manued
I
Marital status
Husband's name
(single, married, widowed, divorced)
Baldium L. Keyes, M.D.
Permanent address
Walnut st. Phila thila
ta
(street)
(city)
(county)
(state)
Probable address
for the next year
Walnut St thila. Phila
ta
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
Baldivin (name) Keyer (relationship) husland 2025 (address) Walnut St.
Phila. Pa.
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)
K
Government Service: Army, Regular
Navy, Regular
Veterans Administration
Reserve
Reserve
Children's Bureau
U.S.P.H. Service
U.S. Indian Service
to
+
MAJOR RESPONSIBILITIES
Administration
Teaching
Private duty
of present employment
Supervision
General Staff
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)
94rs. in
Psychiatric Nursing
Peinum Hap.
Operating room
Anaesthesia
for newors
Public
health nursing siberia with Red cross nursing
of mental
8 months in
Russian soldiers
2. Have you taken any courses in a college or university
history P.H.D. taking Diseaus - mental
Less than
One
Two
Three
Four
Bachelor's
Master's
*one year
year
years
years
years
degree
degree
degree
Public Health
Certificate in tests
In what major field was above study? History
What benden
Cartler
languages, other than English, do you speak? none - - some
*Academic year
some Russian (OVER)
Page data
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- Source index
- 0
- Type
- photo
- Media ID
- 9163517720eb11c7
- Size
- unknown
Document data
- ID
- 2661752
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName in full Keyes (last\nHarriet\n(first)\n(middle\nKift\nTel. No. Pittenbouse 1515\nIf\nmarried,\ngive\nmaiden name Harriet charlton Kift\nYear of birth 1892\nmanued\nI\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nBaldium L. Keyes, M.D.\nPermanent address\nWalnut st. Phila thila\nta\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\nWalnut St thila. Phila\nta\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nBaldivin (name) Keyer (relationship) husland 2025 (address) Walnut St.\nPhila. Pa.\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\nIndustrial\nPrivate duty\nOther (write in)\nK\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nto\n+\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL?\nOne\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)\n94rs. in\nPsychiatric Nursing\nPeinum Hap.\nOperating room\nAnaesthesia\nfor newors\nPublic\nhealth nursing siberia with Red cross nursing\nof mental\n8 months in\nRussian soldiers\n2. Have you taken any courses in a college or university\nhistory P.H.D. taking Diseaus - mental\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nCertificate in tests\nIn what major field was above study? History\nWhat benden\nCartler\nlanguages, other than English, do you speak? none - - some\n*Academic year\nsome Russian (OVER)"
}