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M ar K RED CROSS BADGE NUMBER AMERICAN RED CROSS 17177 NURSING SERVICES MILITARY SERIAL NUMBER L ANNUAL QUESTIONNAIRE - 1945 e CHECK IF YOUR LAST NAME HAS CHANGED NAME (Last, first, middle) TELEPHONE NO. to IF MARRIED, GIVE MAIDEN Veta NAME Blanche HUSBAND'S NAME PERMANENT ADDRESS (Street, city, zone, county, state) B 8.Vitnano Hospital, Kndville PRESENT ADDRESS (Street, cl/ty, zone, county, state) mairan county Lowa - 48, Vituano Hoskital Kundville NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES mairon RELATIONSHIP country Darna mus Laura E. markley west Paint Illenous mother DATE OF BIRTH (Month, day, year) Single Married Widowed Divorced nov. 29-1892 Separated WHAT LANGUAGES DO YOU SPEAK? YES NO English HIGH SCHOOL GRADUATE NAME OF COLLEGE OR DEGREE OR UNIVERSITY ATTENDED LOCATION INCLUSIVE DATES DIPLOMA MAJOR ARE YOU CURRENTLY YES NO REGISTERED IN (State) ARE YOU CURRENTLY A MEMBER OF THE AMERICAN YES NO REGISTERED? Illinais NURSES' ASSOCIATION? PRESENT EMPLOYMENT If not employed, check POSITION TITLE (H.N., P.D., inst., staff nurse, etc.) SERVICE (Medicine, surgery, etc.) Repatered nurse NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED numoprychintic CITY runing STATE u.8. Vetuans Hospital Knerville gorra HEALTH IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY good VOLUNTEER SERVICE The purpose of the following statements is to identify the nurses who can be counted upon to respond to a cal to participate in a Red Cross chapter program. Please check the "Yes" box only if you are willing and able to serve if called on vithin the next 12 months. NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS KNOXVILLI chAp. palk Country chapter 312 T lysics Bedy Dec 20pr YES YA NO 1. Teach home YES NO (t tend an instructors' training program, 1f offered. (Funds are available for nursing classes training home nursing instructors. See local chapter.) 2. Serve in case YES NO only in home community Attend disaster institutes, if YES NO of disaster In other communities offered, in preparation for service 3. Teach nurse's YES NO 4. Accept membership on chapter com- YES NO 5. Assist with other chapter YES NO aide classes mittee should services be needed programs, as needed If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that YES NO you will be able to serve at some time in the future? IF UNABLE TO SERVE, GIVE MAJOR REASONS- here DATE am employed the Veterans administration Hosfital and hoge to remain 9 SIGNATURE august 17-1945 Veta Blanche Markley YOUR FALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPULNESS KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO the COMMITTEE NAMED BELOW. ATTENTION Fill in committee name and address before sending questionnaire to nurseRecruitment Committee SECRETARY Polk County Chapter ARC NURSE RECRUITMENT Les 112 Flyon COMMITTEE Des Moines, - Iowa 78504M FORM 1045 Rev. July 1945

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    "ocrText": "M\nar\nK\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n17177\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nL\nANNUAL QUESTIONNAIRE - 1945\ne\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nto\nIF MARRIED, GIVE MAIDEN Veta NAME Blanche\nHUSBAND'S NAME\nPERMANENT ADDRESS (Street, city, zone, county, state)\nB\n8.Vitnano Hospital, Kndville\nPRESENT ADDRESS (Street, cl/ty, zone, county, state)\nmairan county Lowa\n-\n48, Vituano Hoskital Kundville\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nmairon RELATIONSHIP country Darna\nmus Laura E. markley west Paint Illenous\nmother\nDATE OF BIRTH (Month, day, year)\nSingle\nMarried\nWidowed\nDivorced\nnov. 29-1892\nSeparated\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\nEnglish\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nIllinais\nNURSES' ASSOCIATION?\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nRepatered nurse\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nnumoprychintic CITY runing STATE\nu.8. Vetuans Hospital\nKnerville\ngorra\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\ngood\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a cal\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able to\nserve if called on vithin the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nKNOXVILLI\nchAp.\npalk Country chapter 312 T lysics Bedy Dec 20pr YES YA NO\n1. Teach home\nYES\nNO\n(t tend an instructors' training program, 1f offered. (Funds are available for\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof disaster\nIn other communities\noffered, in preparation for service\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\naide classes\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS-\nhere\nDATE am employed the Veterans administration Hosfital and hoge to remain\n9\nSIGNATURE\naugust 17-1945\nVeta Blanche Markley\nYOUR FALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPULNESS\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO the\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurseRecruitment\nCommittee\nSECRETARY\nPolk County Chapter ARC\nNURSE RECRUITMENT\nLes\n112 Flyon\nCOMMITTEE\nDes Moines, - Iowa\n78504M\nFORM 1045 Rev. July 1945"
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