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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)
Page data
- Page
- 29
- Source index
- 0
- Type
- photo
- Media ID
- 4aca43cbacdf59af
- Size
- unknown
Document data
- ID
- 2661820
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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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)"
}