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THE AMERICAN NATIONAL RED CROSS NURSING SERVICE
Form 1037
Rev. 1-24-36.
Application for Enrollment
(To be filled out entirely in applicant's handwriting and each question answered fully.)
1.
Name of applicant in full
Ruth Layton
If married, give maiden name
*2.
Permanent
address in full. maravian Falls n.c.
Date of birth nov. 7, 1902 Race. Place of birth wilked Ca ,N.C
Probable address for one year state Department white of health, Charlestan W. vas. -L
3 3.
(Month)
(Day)
(Year)
3
Birthplace of father n.c
Mother. n.c Citizenship of father american
Are you a citizen of the United
4.
States? yes single
J
Are you single, married, a widow, or divorced?
5. How many years have you attended Grammar School? 7 High school # Normal school?
Private school?
College? 4 If tutored privately, name subjects covered and length
of time
6. What languages other than English do you speak?
none
(Underline those which you speak fluently)
7. Occupation before entering school of nursing
student
8.
From what school of nursing did you receive your diploma? Davis Hospital
City and State Statesville, n.c. Date of graduation march 1927
9. Character of Hospital: General?
Special?
Private?
2
10. Did your training include medical and surgical care of men? L
Of women?
Pediatrics? no
Obstetrics?
Communicable diseases? no
11. Daily average number of patients in hospital during training 40-50 Length of course 3 years
12. Name and address of director of school of nursing under whom you received training
miss Eligabeth Hill, Davis Hospital, Statesville n.c.
13. If your education as a nurse was received in more than one hospital, give name, location and
0
14.
Are Postgraduate you à member of your Alumnae Association? signal Chicago
time spent in each 6 mo hospital, 6no Davis Hospital years;
15. Are you affiliated with the American Nurses' Association through membership in District and
State Associations?
Affiliation with the American Nucses' Association means active membership in the District and Graduate Nurses' Associations
yes
of the state in which you are living at the present time.
16.
Give name and address of secretary of the District or State Association of which you are a
member Miss Sarah Cartwright nachville Jenn.
17.
Are you a registered nurse? yes In what State?n.C. Date of registration 8032
18. Type of work and length of service since graduation:
Private Duty turning 6 months
Office Uursing for private physician 3mouths
Tuchercularic control 41/2 years & generalized Country work'mith
supervis Tenn state Departmenthfulth va. Jannow employed field
19.
Are you willing to accept service if the United States becomes involved in war? yes
Or, service with the American Red Cross in time of disaster or great emergency? yes
Check to indicate whether you would prefer assignment with the Army Nurse Corps
I
or Navy Nurse Corps
20. Are you willing to take the oath of allegiance?
yes
21. Are you a qualified public health nurse, or teacher?
yes
D.
If so, please answer the questions on the reverse side of this blank.
22.
Give name and permanent address of nearest relative or friend, residing in the United States
(state relationship).
mrs W.a. Lauton (mother) Maravian falls n.c.
Date may 12,1936 Signature of Nurse Ruth Layton
*Addresses must be given in full, including street, city and state.
(OVER)
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"ocrText": "THE AMERICAN NATIONAL RED CROSS NURSING SERVICE\nForm 1037\nRev. 1-24-36.\nApplication for Enrollment\n(To be filled out entirely in applicant's handwriting and each question answered fully.)\n1.\nName of applicant in full\nRuth Layton\nIf married, give maiden name\n*2.\nPermanent\naddress in full. maravian Falls n.c.\nDate of birth nov. 7, 1902 Race. Place of birth wilked Ca ,N.C\nProbable address for one year state Department white of health, Charlestan W. vas. -L\n3 3.\n(Month)\n(Day)\n(Year)\n3\nBirthplace of father n.c\nMother. n.c Citizenship of father american\nAre you a citizen of the United\n4.\nStates? yes single\nJ\nAre you single, married, a widow, or divorced?\n5. How many years have you attended Grammar School? 7 High school # Normal school?\nPrivate school?\nCollege? 4 If tutored privately, name subjects covered and length\nof time\n6. What languages other than English do you speak?\nnone\n(Underline those which you speak fluently)\n7. Occupation before entering school of nursing\nstudent\n8.\nFrom what school of nursing did you receive your diploma? Davis Hospital\nCity and State Statesville, n.c. Date of graduation march 1927\n9. Character of Hospital: General?\nSpecial?\nPrivate?\n2\n10. Did your training include medical and surgical care of men? L\nOf women?\nPediatrics? no\nObstetrics?\nCommunicable diseases? no\n11. Daily average number of patients in hospital during training 40-50 Length of course 3 years\n12. Name and address of director of school of nursing under whom you received training\nmiss Eligabeth Hill, Davis Hospital, Statesville n.c.\n13. If your education as a nurse was received in more than one hospital, give name, location and\n0\n14.\nAre Postgraduate you à member of your Alumnae Association? signal Chicago\ntime spent in each 6 mo hospital, 6no Davis Hospital years;\n15. Are you affiliated with the American Nurses' Association through membership in District and\nState Associations?\nAffiliation with the American Nucses' Association means active membership in the District and Graduate Nurses' Associations\nyes\nof the state in which you are living at the present time.\n16.\nGive name and address of secretary of the District or State Association of which you are a\nmember Miss Sarah Cartwright nachville Jenn.\n17.\nAre you a registered nurse? yes In what State?n.C. Date of registration 8032\n18. Type of work and length of service since graduation:\nPrivate Duty turning 6 months\nOffice Uursing for private physician 3mouths\nTuchercularic control 41/2 years & generalized Country work'mith\nsupervis Tenn state Departmenthfulth va. Jannow employed field\n19.\nAre you willing to accept service if the United States becomes involved in war? yes\nOr, service with the American Red Cross in time of disaster or great emergency? yes\nCheck to indicate whether you would prefer assignment with the Army Nurse Corps\nI\nor Navy Nurse Corps\n20. Are you willing to take the oath of allegiance?\nyes\n21. Are you a qualified public health nurse, or teacher?\nyes\nD.\nIf so, please answer the questions on the reverse side of this blank.\n22.\nGive name and permanent address of nearest relative or friend, residing in the United States\n(state relationship).\nmrs W.a. Lauton (mother) Maravian falls n.c.\nDate may 12,1936 Signature of Nurse Ruth Layton\n*Addresses must be given in full, including street, city and state.\n(OVER)"
}