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Form 1045
Rev. Nov. 1941
AMERICAN RED CROSS
15
NURSING SERVICE
Ruth
5-6311
Name in full
Laxton
Tel. No.
(last)
(first)
(middle)
Year of birth Nov. 1902
If married, give maiden name
E
Husband's name
Marital status
(single, married, widowed, divorced)
Moravian Falls
Wilkes
Nor th Carolina
Permanent address
(street)
(city)
(county)
(state)
Probable address Genera 1 Hospital Nashiville
Tennessee
for the next year
Davidson
(street)
(city)
(county)
(state)
Give name and address of nearest relative or friend in United States:
Mrs. W. A. Laxton
Mo ther
Moravian Falls, North Carolina
(name)
(relationship)
(address)
Are you employed in nursing at the present time? Yes
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
Institutional
General Hospital
Public health
Industrial
Private duty
Other (write in)
-
Navy, Regular
Veterans Administration
Government Service: Army, Regular
Reserve
Children's Bureau
Reserve
U.S.P.H. Service
U.S. Indian Service
MAJOR RESPONSIBILITIES
Administration
Teaching
Private duty
Supervision
General Staff
Other (specify)
of present employment
How many years did you attend HIGH SCHOOL? One
Two
Three
Four
Graduated
Yes
No
SINCE GRADUATION FROM YOUR SCHOOL OF NURSING
have you ever had-
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
I
Public health nursing
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
degree
degree
degree
Public Health
years
In what major field was above study? Public Health Nursing
What languages, other than English, do you speak?
None
(OVER)
*Academic year
Page data
- Page
- 34
- Source index
- 0
- Type
- photo
- Media ID
- 9718cc323018b05a
- Size
- unknown
Document data
- ID
- 2661809
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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Document source metadata
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Document source extras
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Page context
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"ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\n15\nNURSING SERVICE\nRuth\n5-6311\nName in full\nLaxton\nTel. No.\n(last)\n(first)\n(middle)\nYear of birth Nov. 1902\nIf married, give maiden name\nE\nHusband's name\nMarital status\n(single, married, widowed, divorced)\nMoravian Falls\nWilkes\nNor th Carolina\nPermanent address\n(street)\n(city)\n(county)\n(state)\nProbable address Genera 1 Hospital Nashiville\nTennessee\nfor the next year\nDavidson\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nMrs. W. A. Laxton\nMo ther\nMoravian Falls, North Carolina\n(name)\n(relationship)\n(address)\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nGeneral Hospital\nPublic health\nIndustrial\nPrivate duty\nOther (write in)\n-\nNavy, Regular\nVeterans Administration\nGovernment Service: Army, Regular\nReserve\nChildren's Bureau\nReserve\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nSupervision\nGeneral Staff\nOther (specify)\nof present employment\nHow many years did you attend HIGH SCHOOL? One\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\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\nI\nPublic health nursing\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\ndegree\ndegree\ndegree\nPublic Health\nyears\nIn what major field was above study? Public Health Nursing\nWhat languages, other than English, do you speak?\nNone\n(OVER)\n*Academic year"
}