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FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
If you have changed your last name
Red Cross
since contacting us, please check here.
Badge number 62545
Name in full LEPRESTRE.
Genevieve,
Tel. Nokälaupapa
(last)
(first)
(middle)
Molokai, T.H
If married, give maiden name
Date of birth November I6, I900
Marital status
Single
Husband's name
(single, married, widowed, divorced)
Permanent address c/o R.L.Sabin,Atty.-IIII Wilcox Builg, Portland, Oregon.
(street)
(city)
(county)
(state)
Present address Kalaupapa,
Kalawao, Molokai, T.H.
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
Mrs Henry W. Cornell, Jr, 2I Holmes Run Rd;Falls Church, Va. (Sister)
(name)
(address)
(relationship)
Are you employed in nursing at the present time? Yes
No
If employed, check the type of work you are doing and fill in below the title of your position and the name
and address of the agency or institution:
Institutional
Public Health
Industrial
Private Duty
Other
General duty. heprosy Hospital, Territory or Hawaii
If not employed, what type of nursing would you prefer to render?
IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND
ANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX
AVAILABILITY FOR SERVICE WITH THE ARMED FORCES
Requirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She
may be single or married, but if married she must have no dependents under 14 years of age.
If eligible and not already in service with the armed forces, are you:
Immediately available?
Available in the near future?
(specify date)
Not available, for the following reason?
(specify)
Do you have any dependents under 14 years of age? Yes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes?
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
Yes
To serve overseas caring for civilians?
Yes
the
Have you ever served with the Red Cross in a disaster? Yes
No
If yes, specify type of disaster
Page data
- Page
- 13
- Source index
- 0
- Type
- photo
- Media ID
- 131b27676b78a84e
- Size
- unknown
Document data
- ID
- 2661821
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "FORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nIf you have changed your last name\nRed Cross\nsince contacting us, please check here.\nBadge number 62545\nName in full LEPRESTRE.\nGenevieve,\nTel. Nokälaupapa\n(last)\n(first)\n(middle)\nMolokai, T.H\nIf married, give maiden name\nDate of birth November I6, I900\nMarital status\nSingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address c/o R.L.Sabin,Atty.-IIII Wilcox Builg, Portland, Oregon.\n(street)\n(city)\n(county)\n(state)\nPresent address Kalaupapa,\nKalawao, Molokai, T.H.\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\nMrs Henry W. Cornell, Jr, 2I Holmes Run Rd;Falls Church, Va. (Sister)\n(name)\n(address)\n(relationship)\nAre you employed in nursing at the present time? Yes\nNo\nIf employed, check the type of work you are doing and fill in below the title of your position and the name\nand address of the agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nGeneral duty. heprosy Hospital, Territory or Hawaii\nIf not employed, what type of nursing would you prefer to render?\nIT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND\nANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX\nAVAILABILITY FOR SERVICE WITH THE ARMED FORCES\nRequirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She\nmay be single or married, but if married she must have no dependents under 14 years of age.\nIf eligible and not already in service with the armed forces, are you:\nImmediately available?\nAvailable in the near future?\n(specify date)\nNot available, for the following reason?\n(specify)\nDo you have any dependents under 14 years of age? Yes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes?\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\nYes\nTo serve overseas caring for civilians?\nYes\nthe\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nIf yes, specify type of disaster"
}