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FORM 1045
REV. JAN 1941
AMERICAN RED CROSS
2H
NATIONAL HEADQUARTERS
WASHINGTON, D. C.
LEPRESTRE
GENEVIEVE
Name in full
Year of Birth I900
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
2334 N.W.NORTHRUP, PORTLAND, OREGON.
Permanent address
(STREET)
(CITY)
(COUNTY)
(STATE)
Probable address
Same
for the next year
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
Beacon 82I7.
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
Mrs Henry E.Cornell, (Sister) 48 Bayway Ave, Brightwaters, Long Island, N.Y.
(NAME)
(RELATIONSHIP)
(ADDRESS)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
Public Health
Private duty
X
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
MAJOR RESPONSIBILITIES
Adminis
Super-
Teach-
General
Private
Other
of present employment
tration
vision
ing
Staff
Duty
(specify)
IF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other
(WRITE IN)
AVAILABILITY
At the present time would you
Date
accept assignment to the Army? Yes
X
No
Navy? Yes
No
available
Now
In case of a war emergency would you
accept assignment to the Army? Yes
No
Navy?
Yes
No
If not now employed would you
accept nursing work? Full-time? Yes
No
Part-time? Yes
No
In your own community? Yes
No
Elsewhere? Yes
No
Would you be interested in teaching classes in Home Hygiene and Care of the Sick? NO
Present physical condition
Good
62545
Badge No.
Current date 2-2I-4I
Oregon State & Local
Name of Committee
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enrollment will be removed from our active files.
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- 9bc48612b1e7b5c9
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Document data
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- 2661821
- Core
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- Type
- document
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Context sent to Scholar
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"month": 9,
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"logicalDate": "1934-11-21",
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"ocrText": "+\nFORM 1045\nREV. JAN 1941\nAMERICAN RED CROSS\n2H\nNATIONAL HEADQUARTERS\nWASHINGTON, D. C.\nLEPRESTRE\nGENEVIEVE\nName in full\nYear of Birth I900\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\n2334 N.W.NORTHRUP, PORTLAND, OREGON.\nPermanent address\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address\nSame\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\nBeacon 82I7.\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nMrs Henry E.Cornell, (Sister) 48 Bayway Ave, Brightwaters, Long Island, N.Y.\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nPublic Health\nPrivate duty\nX\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nMAJOR RESPONSIBILITIES\nAdminis\nSuper-\nTeach-\nGeneral\nPrivate\nOther\nof present employment\ntration\nvision\ning\nStaff\nDuty\n(specify)\nIF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther\n(WRITE IN)\nAVAILABILITY\nAt the present time would you\nDate\naccept assignment to the Army? Yes\nX\nNo\nNavy? Yes\nNo\navailable\nNow\nIn case of a war emergency would you\naccept assignment to the Army? Yes\nNo\nNavy?\nYes\nNo\nIf not now employed would you\naccept nursing work? Full-time? Yes\nNo\nPart-time? Yes\nNo\nIn your own community? Yes\nNo\nElsewhere? Yes\nNo\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick? NO\nPresent physical condition\nGood\n62545\nBadge No.\nCurrent date 2-2I-4I\nOregon State & Local\nName of Committee\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enrollment will be removed from our active files."
}