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Form 1045 Rev. Nov. 1942 AMERICAN RED CROSS NURSING SERVICE DEC 20 1942 If you have changed your last name since Patry Licile contacting us, please check here Name in full Tel. No. wisconsin 3547 (last) (first) (middle) If married, give maiden name. Date of birth Jan. 23, 1902 Marital status. Single Husband's name (single, married, widowed, divorced) Permanent address & Fellon Kent Delaware (street) (city) (county) (state) Probable address for the next year 4511 montgomery Maryland (street) (city) (county) (state) Give name and address of nearest relative or friend in United States: D. A. Petry falley Felton Delaware (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 Public health 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) nursing Educalim Consultant 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? yes B.A Did you have a five-year course granting bachelor's degree? 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? nursing Education 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? Have you ever had any other air experience? Yes No Specify (OVER)

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Page context
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    "ocrText": "Form 1045\nRev. Nov. 1942\nAMERICAN RED CROSS\nNURSING SERVICE\nDEC 20 1942\nIf you have changed your last name since\nPatry\nLicile\ncontacting us, please check here\nName in full\nTel. No. wisconsin 3547\n(last)\n(first)\n(middle)\nIf married, give maiden name.\nDate of birth Jan. 23, 1902\nMarital status.\nSingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address &\nFellon\nKent\nDelaware\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\n4511 montgomery Maryland\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nD. A. Petry\nfalley\nFelton Delaware\n(name)\n(relationship)\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\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) nursing Educalim\nConsultant\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? yes B.A\nDid\nyou have a five-year course granting bachelor's degree?\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\n+\nIn what major field was above study?\nnursing Education\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?\nHave you ever had any other air experience?\nYes\nNo\nSpecify\n(OVER)"
}