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FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
Red Cross
If you have changed your last name
Badge number 23972
since contacting us, please check here.
Name in
full LATus
Lillian
Violo
Tel. No 1-1492.
(last)
(first)
(middle)
L
If married, give maiden name
no
Date of birth april 29-1892
Marital status
single
Husband's name
0
(single, married, widowed, divorced)
-
Permanent address 243 maple (street) st. new (city) Britain Hartford, (county) Conn. (state) Youther
/°
Present address 1310-Punahus st. Polio Hospital
Honolulu
Jahu T-H.
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
min Jane Rock, 243 maple st new Britain, Conn. (friend.)
(name)
(address)
(relationship)
Are you employed in nursing at the present time? Yes
No
If employed, check the type of work you are doing and fill in below the title of your position and the name
and address of the agency or institution:
Institutional
Public Health
Industrial
Private Duty
Other
Polio nursing
If not employed, what type of nursing would you prefer to render?
IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND
ANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX
AVAILABILITY FOR SERVICE WITH THE ARMED FORCES
Requirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She
may be single or married, but if married she must have no dependents under 14 years of age.
If eligible and not already in service with the armed forces, are you
Immediately available?
Available in the near future?
(specify date)
Not
available, for the following reason? Over age (specify) limit
Do you have any dependents under 14 years of age? Yes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes
no working 4-12 sl - pm .. permanently
To teach volunteer nurse's aides?
no .
To take a Red Cross emergency assignment? If needed
To serve overseas caring for civilians? In Hawaii
Have you ever served with the Red Cross in a disaster? Yes
No
If yes, specify type of disaster
W
of
J
2
Page data
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- Source index
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- Type
- photo
- Media ID
- aa58891cf7c02d38
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- unknown
Document data
- ID
- 2661803
- Core
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- Type
- document
DTO data
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Page context
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"ocrText": "a\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nRed Cross\nIf you have changed your last name\nBadge number 23972\nsince contacting us, please check here.\nName in\nfull LATus\nLillian\nViolo\nTel. No 1-1492.\n(last)\n(first)\n(middle)\nL\nIf married, give maiden name\nno\nDate of birth april 29-1892\nMarital status\nsingle\nHusband's name\n0\n(single, married, widowed, divorced)\n-\nPermanent address 243 maple (street) st. new (city) Britain Hartford, (county) Conn. (state) Youther\n/°\nPresent address 1310-Punahus st. Polio Hospital\nHonolulu\nJahu T-H.\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\nmin Jane Rock, 243 maple st new Britain, Conn. (friend.)\n(name)\n(address)\n(relationship)\nAre you employed in nursing at the present time? Yes\nNo\nIf employed, check the type of work you are doing and fill in below the title of your position and the name\nand address of the agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nPolio nursing\nIf not employed, what type of nursing would you prefer to render?\nIT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND\nANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX\nAVAILABILITY FOR SERVICE WITH THE ARMED FORCES\nRequirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She\nmay be single or married, but if married she must have no dependents under 14 years of age.\nIf eligible and not already in service with the armed forces, are you\nImmediately available?\nAvailable in the near future?\n(specify date)\nNot\navailable, for the following reason? Over age (specify) limit\nDo you have any dependents under 14 years of age? Yes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes\nno working 4-12 sl - pm .. permanently\nTo teach volunteer nurse's aides?\nno .\nTo take a Red Cross emergency assignment? If needed\nTo serve overseas caring for civilians? In Hawaii\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nIf yes, specify type of disaster\nW\nof\nJ\n2"
}