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K - 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)

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73
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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)"
}