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-
Form 1045
AMERICAN RED CROSS
DEC 1 6 1941
Rev. Nov. 1941
A
NURSING SERVICE
#
9
Name in full Kloma n
Agnes
Prokett
Tel. No. Warrenton 48-
5
(last)
(ffrst)
(middle)
If married, give maiden name
Single
Year of birth 1874
s
Marital Single
status.
Husband's name Hare none
(single, married, widowed, divorced)
Permanent address 600 EdgEVALE Road Betwine
Balhwore-Md.
(street)
(city)
(county)
(state)
Probable
for the
next address year Heretels (street) Spring Then Dennis- Cape od Macraelundities
(city)
(county)
(state)
Dr E H. Kloman - Brother or - 600Edgevaleth Bothmore
Give name and address of nearest relative friend in United States:
(name)
(relationship)
-
Are you employed in nursing at the present time? Yes
No
and
Pair
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
noue
-
/
,
Institutional
Public health
Industrial
Private duty
Other (write in)
Red Coaks nurse in tent marld wer -
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
x
Teaching
Private duty
of present employment
Supervision
General Staff
Other (specify)
x Public Health
How many years did you attend HIGH SCHOOL? One
Two
Three
Four
Graduated
Governess, Private aud teaction College Ostanitia
SINCE GRADUATION FROM YOUR SCHOOL OF NURSING 8 unner course - Parked
have you ever had-
exams- -
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)
Psychiatric Nursing
Operating room
Anaesthesia
Public health nursing of
2. Have you taken any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
P.H.D.
Certificate in
*one year
year
years
years
years
degree
degree
degree
Public Health
In what major field was above study? Person Hygieu Public Health minine -
What languages, other than English, do you speak? have - Enough theuer about
Academic year
Paris in jist med was
(OVER)
Page data
- Page
- 73
- Source index
- 0
- Type
- photo
- Media ID
- 29988f7085431c71
- Size
- unknown
Document data
- ID
- 2661767
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source extras
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"ocrText": "K\n-\nForm 1045\nAMERICAN RED CROSS\nDEC 1 6 1941\nRev. Nov. 1941\nA\nNURSING SERVICE\n#\n9\nName in full Kloma n\nAgnes\nProkett\nTel. No. Warrenton 48-\n5\n(last)\n(ffrst)\n(middle)\nIf married, give maiden name\nSingle\nYear of birth 1874\ns\nMarital Single\nstatus.\nHusband's name Hare none\n(single, married, widowed, divorced)\nPermanent address 600 EdgEVALE Road Betwine\nBalhwore-Md.\n(street)\n(city)\n(county)\n(state)\nProbable\nfor the\nnext address year Heretels (street) Spring Then Dennis- Cape od Macraelundities\n(city)\n(county)\n(state)\nDr E H. Kloman - Brother or - 600Edgevaleth Bothmore\nGive name and address of nearest relative friend in United States:\n(name)\n(relationship)\n-\nAre you employed in nursing at the present time? Yes\nNo\nand\nPair\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nnoue\n-\n/\n,\nInstitutional\nPublic health\nIndustrial\nPrivate duty\nOther (write in)\nRed Coaks nurse in tent marld wer -\nGovernment Service:\nArmy, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nx\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nx Public Health\nHow many years did you attend HIGH SCHOOL? One\nTwo\nThree\nFour\nGraduated\nGoverness, Private aud teaction College Ostanitia\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING 8 unner course - Parked\nhave you ever had-\nexams- -\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)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing of\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nIn what major field was above study? Person Hygieu Public Health minine -\nWhat languages, other than English, do you speak? have - Enough theuer about\nAcademic year\nParis in jist med was\n(OVER)"
}