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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
Page data
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- Source index
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- Type
- photo
- Media ID
- 7b8ed721ac825503
- Size
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Document data
- ID
- 2661789
- Core
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- Type
- document
DTO data
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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"
}