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m Chicago Form 1045 ge Rev. Nov. 1942 AMERICAN RED CROSS NURSING SERVICE If you have changed your last name since contacting us, please check here Name in full LEiDig (last) gRayez B. Tel. No. (middle) If married, give maiden name Date of birth 5-30-05 Marital status Dingle Husband's name (single, married, widowed, divorced) Permanent address 1848 n. Keyzica Change, cook Ice (street) (city) (county) (state) Probable address for the next year Le. A. army (city) (county) (state) Give name and address of nearest relative or friend in United States: mis minnie (name) Loading (relationship) Stepmother 1848 x Kedgie Over Change (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 Public health n y. State Dept. of H. Before entering army Industrial Private duty Other (write in) Government Service: Army, Regular Navy, Regular Veterans Administration Reserve Reserve Children's Bureau U.S.P.H. Service U.S. Indian Service MAJOR RESPONSIBILITIES Administration Teaching Private duty of present employment Supervision General staff Other (specify) If not employed, what type of nursing would you prefer to render? How many years did you attend HIGH SCHOOL? One Two Three Four Graduated Yes No Before entering training, how many years did you attend COLLEGE? name State california Did you have a five-year course granting bachelor's degree? no AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have- Postgraduate course in a hospital Experience in hospital 1. A postgraduate course or experience in any of the following services? (at least 3 months) (at least 6 months) Communicable disease nursing (include tuberculosis) Psychiatric nursing Operating room Anaesthesia 2. Have you had any courses in a college or university? Less than One Two Three Four Bachelor's Master's Ph.D. M. D. one academic year year years years years degree degree degree degree In what major field was above study? Publis Health 3. Training and experience in the public health field: Postgraduate 4 months or more Certificate Degree Experience 6 months Have you ever held a position as an air hostess? Yes No How long? S Have you ever had any other air experience? Yes No Specify Have flown over 20, (OVER)

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0
Type
photo
Media ID
4893ef27f92ace66
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2661817
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Context sent to Scholar

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Document source extras
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Page context
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    "ocrText": "m\nChicago\nForm 1045\nge\nRev. Nov. 1942\nAMERICAN RED CROSS\nNURSING SERVICE\nIf you have changed your last name since\ncontacting us, please check here\nName in full LEiDig (last)\ngRayez\nB.\nTel. No.\n(middle)\nIf married, give maiden name\nDate of birth 5-30-05\nMarital status\nDingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 1848 n. Keyzica Change, cook\nIce\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\nLe. A. army\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nmis minnie (name) Loading (relationship) Stepmother\n1848 x Kedgie Over Change\n(address)\nAre you employed in nursing at the present time?\nYes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nn y. State Dept. of H. Before entering army\nIndustrial\nPrivate duty\nOther (write in)\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral staff\nOther (specify)\nIf not employed, what type of nursing would you prefer to render?\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nBefore entering training, how many years did you attend COLLEGE? name\nState california\nDid you have a five-year course granting bachelor's degree? no\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-\nPostgraduate course\nin a hospital\nExperience in hospital\n1. A postgraduate course or experience in any of the following services? (at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include tuberculosis)\nPsychiatric nursing\nOperating room\nAnaesthesia\n2. Have you had any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\nM. D.\none academic year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\nIn what major field was above study? Publis Health\n3. Training and experience in the public health field: Postgraduate 4 months or more\nCertificate\nDegree\nExperience 6 months\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\nS\nHave you ever had any other air experience?\nYes\nNo\nSpecify Have flown over 20,\n(OVER)"
}