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H.D.
June21, 1940.
FORM 1045
AMERICAN RED CROSS
REV. DEC. 1939
NATIONAL HEADQUARTERS
Referrod to
WASHINGTON. D.C.
Name in full
Laxton
Ruth
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
Moravian Falls,
Wilkes
North Carolina
Permanent address
(STREET)
(CITY)
(COUNTY)
(STATE)
Probable address
co
Rutherford County Health Department, Murfreesboro
Rutherford
Tenn.
for the next year
(STREET)
(CITY)
(COUNTY)
(STATE)
1271
Telephone number
(EXCHANGE)
(NO.)
Nearest relative or friend in United States, through whom you may be communicated with in
an emergency:
Mrs. W. A Laxton
Mother
(NAME)
(RELATIONSHIP)
Moravian Falls North Carolia
(STREET)
(CITY)
(STATE)
PRESENT WORK (check below)
Name of agency or institution with which employed
Institutional
(Rutherford County Health Department and
Public Health
(State..Teachers.!..College, Murfreesboro, Tenn-
Private duty
Other (write in)
Government Service: Army
U.S.P.H.Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
IF
NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other (write in)
Would you respond to an emergency call in event of local or national emergency, such as
epidemic, flood, war, etc.
Yes
(Granted of course that you could be released from present employment)
Present physical condition
Good
Yes
Would you be interested in teaching classes in Home Hygiene and Care of the Sick?
I
Are you a member of the American Nurses' Association?
Yes
If not, why have you allowed your membership to lapse?
D.
Badge No. Home Defense
Current date October 30, 1940
Name of Committee I am not working with a committee at the present time
U
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enrollment will be removed from our active files.
2
Page data
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- 39
- Source index
- 0
- Type
- photo
- Media ID
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- Size
- unknown
Document data
- ID
- 2661809
- Core
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- Type
- document
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"ocrText": "H.D.\nJune21, 1940.\nFORM 1045\nAMERICAN RED CROSS\nREV. DEC. 1939\nNATIONAL HEADQUARTERS\nReferrod to\nWASHINGTON. D.C.\nName in full\nLaxton\nRuth\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nMoravian Falls,\nWilkes\nNorth Carolina\nPermanent address\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address\nco\nRutherford County Health Department, Murfreesboro\nRutherford\nTenn.\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\n1271\nTelephone number\n(EXCHANGE)\n(NO.)\nNearest relative or friend in United States, through whom you may be communicated with in\nan emergency:\nMrs. W. A Laxton\nMother\n(NAME)\n(RELATIONSHIP)\nMoravian Falls North Carolia\n(STREET)\n(CITY)\n(STATE)\nPRESENT WORK (check below)\nName of agency or institution with which employed\nInstitutional\n(Rutherford County Health Department and\nPublic Health\n(State..Teachers.!..College, Murfreesboro, Tenn-\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H.Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nIF\nNOT ACTIVE IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nWould you respond to an emergency call in event of local or national emergency, such as\nepidemic, flood, war, etc.\nYes\n(Granted of course that you could be released from present employment)\nPresent physical condition\nGood\nYes\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick?\nI\nAre you a member of the American Nurses' Association?\nYes\nIf not, why have you allowed your membership to lapse?\nD.\nBadge No. Home Defense\nCurrent date October 30, 1940\nName of Committee I am not working with a committee at the present time\nU\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enrollment will be removed from our active files.\n2"
}