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LaMalle, Mrs. Helen Rafferty 43,588 RED CROSS BADGE AMERICAN RED CROSS 43588 NUMBER art to chet 4/7 NURSING SERVICES MILITARY SERIAL NUMBER 4/15me ANNUAL QUESTIONNAIRE - 1945 CHECK IF YOUR LAST NAME HAS CHANGED NAME/ (Last, first, middle) TELEPHONE NO. Lamalle Helen b. IF MARRIED, GIVE MAIDEN NAME HUSBAND'S NAME Helen b. Rafferty William b. La malle Plaza 2200 PERMANENT ADDRESS (Street, city, zone, county, state) PRESENT ADDRESS (Street, city, zone, county, state) 6930 so Share Drive Chicago, lee Same as above NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES RELATIONSHIP DATE OF BIRTH (Month, day, year) Mrs Thomas Coughlan 7962 Phillips are Chicago le Daughter Sept 22-1880 Single Married Separated Widowed Divorced WHAT LANGUAGES DO YOU SPEAK? NAME OF COLLEGE OR English YES NO HIGH SCHOOL GRADUATE DEGREE OR UNIVERSITY ATTENDED LOCATION INCLUSIVE DATES DIPLOMA MAJOR Columbia University 1916 no Cublis Health School of Cinio 1917 " " ARE YOU CURRENTLY YES NO REGISTERED IN (State) ARE YOU CURRENTLY A MEMBER OF THE AMERICAN YES NO REGISTERED? NURSES' ASSOCIATION? PRESENT EMPLOYMENT If not employed, check POSITION TITLE (H.N., P.D., inst., staff nurse, etc.) SERVICE (Medicine, surgery, etc.) NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED CITY STATE HEALTH IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY VOLUNTEER SERVICE The purpose of the following statements 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 if you are willing 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 1. Teach home Things YES NO Chapter Attend an instructors' training program, 1f 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, if 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. DATE 4/10/46 SIGNATURE Helen La Mall YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFULNESS 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. 031411 SECRETARY NURSE RECRUITMENT COMMITTEE NATIONAL HEADQUARTERS 78504M FORM 1045 Rev. July 1945

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Page context
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    "ocrText": "LaMalle, Mrs. Helen Rafferty 43,588\nRED CROSS BADGE\nAMERICAN RED CROSS\n43588 NUMBER art to chet 4/7\nNURSING SERVICES\nMILITARY SERIAL NUMBER\n4/15me\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME/ (Last, first, middle)\nTELEPHONE NO.\nLamalle Helen b.\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nHelen b. Rafferty\nWilliam b. La malle\nPlaza 2200\nPERMANENT ADDRESS (Street, city, zone, county, state)\nPRESENT ADDRESS (Street, city, zone, county, state)\n6930 so Share Drive Chicago, lee\nSame as above\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nDATE OF BIRTH (Month, day, year)\nMrs Thomas Coughlan 7962 Phillips are Chicago le\nDaughter\nSept 22-1880\nSingle\nMarried\nSeparated\nWidowed\nDivorced\nWHAT LANGUAGES DO YOU SPEAK?\nNAME OF COLLEGE OR\nEnglish\nYES\nNO\nHIGH SCHOOL GRADUATE\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nColumbia University\n1916\nno\nCublis Health\nSchool of Cinio\n1917\n\"\n\"\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nNURSES' ASSOCIATION?\nPRESENT\nEMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nVOLUNTEER SERVICE\nThe purpose of the following statements 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 if you are willing 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\n1. Teach\nhome Things YES NO Chapter\nAttend an instructors' training program, 1f 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, if\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.\nAssist 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.\nDATE\n4/10/46\nSIGNATURE Helen La Mall\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFULNESS\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.\n031411\nSECRETARY\nNURSE RECRUITMENT\nCOMMITTEE\nNATIONAL HEADQUARTERS\n78504M\nFORM 1045 Rev. July 1945"
}