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L
a
MADIRIMA
Are you now a member of the Aerial Nurse Corps of America? Yes
No
I
Have you ever held a position as an air hostess? Yes
No
How long?
FIRST RESERVE NURSES (Single and under 40 years)
If not already serving with the armed forces, when and under what circumstances will you be available?
l prefer to remain in Public Health work
SECOND RESERVE NURSES (Married or over 40, or those notified of this classification because of physical disability)
In case of unlimited national emergency, do you have home or occupational responsibilities which will limit your
field of service? Please specify.
E
If so, what type of nursing would you prefer to render?
If not already teaching Red Cross Home Nursing classes would you be interested in doing so?
No
Would you be interested in teaching the course for Volunteer Nurse's Aides?
No
Present physical condition
good
+
If any disabilities, please specify
Badge No.
81,228
Current date
Jan.31,1942
Name of Committee
(To be is sent to the nurse)
Buffals filled in by Committee before questionnaite n.y
YOUR VALUE AS A RED CROSS RESERVE NURSE DEPENDS ON OUR ABILITY TO LOCATE YOU. THE NATIONAL
EMERGENCY EMPHASIZES THIS FACT MORE THAN EVER. THANK YOU FOR FILLING IN THIS QUESTIONNAIRE
AND RETURNING IT TO US.
FEB 3121942
801
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