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44743
RED CROSS BADGE NUMBER
AMERICAN RED CROSS
mm placed
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
TELEPHONE NO.
NAME (Last, first, middle)
Maurin 9mma
HUSBAND'S NAME
C3896 g
in
IF MARRIED, GIVE MAIDEN NAME
in
PERMANENT city, zone, county, state)
ADDRESS 332 (Street, Helois st metairie for
a
PRESENT ADDRESS (street, city, zone, county, state)
same
NAME Laciell AND mawin 150 Rosewood Drive metaine fa
ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
niece
DATE OF BIRTH (Month,
day
year)
Single
Married
Separated
Widowed
Divorced
2/18/88
YES
NO
WHAT LANGUAGES DO YOU SPEAK?
HIGH SCHOOL GRADUATE
fren eld
NAME OF COLLEGE OR
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
Western Resume h.
Clanel and
40-41
CPH4
PHN
YES
REGISTERED (State) fa
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
ARE YOU CURRENTLY
NO
IN
REGISTERED?
9
4
NURSES' ASSOCIATION?
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.)
SERVICE (Medicine, surgery, etc.)
ORGANIZATION Pubice BY WHOM Hearte EMPLOYED
P where Heart
NAME OF HOSPITAL OR
Fu. State Health
new CI/YY terricus STATE fa.
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
HEALTH good
VOLUNTEER SERVICE
the purpose of the following statements is to identify the nurses who can be counted upon to respond to a call
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 within the next 12 months.
NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS
N.O. Chaper
1. Teach home
YES
Attend an instructors' training program, if offered. (Funds are available for
YES
NO
NO
nursing classes
training home nursing instructors. See local chapter.)
2. Serve in case
NO
only in home community
Attend disaster institutes, if
YES
NO
YES
of disaster
In other communities
offered, in preparation for service
5. Assist with other chapter
YES
NO
3. Teach nurse's
YES
NO
4. Accept membership on chapter cóm-
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?
yes
DATE >UNABLE TO wide SERVE, portuni GIVE MAJOR REASONS probubts my S helping IGNATURE is mything manim but discuster
IF,
YOUR VALUE 16 4 RED CROSS NURSE DEPENDS or YOUR ABILITY IN
AND WILLINGIESS mm to SERVE AND YOUR PAITEPOLNESS
KEEPING US INPORNED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONFAIRE AND REfURN If PRONPILY TO THE
COMMIFTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
N. O. CHAPTER
NURSE RECRUITMENT
COMMITTEE
AMERICAN RED CROSS
78504M
2127 PRYTANIA STREET
FORM 1045 Rev. July 1945
NPW ORLEANS 13, LA.
Page data
- Page
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- Source index
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- Type
- photo
- Media ID
- 5afca0d84104e407
- Size
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Document data
- ID
- 2661903
- Core
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- Type
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DTO data
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Context sent to Scholar
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"ocrText": "M\na\n44743\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\nmm placed\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nTELEPHONE NO.\nNAME (Last, first, middle)\nMaurin 9mma\nHUSBAND'S NAME\nC3896 g\nin\nIF MARRIED, GIVE MAIDEN NAME\nin\nPERMANENT city, zone, county, state)\nADDRESS 332 (Street, Helois st metairie for\na\nPRESENT ADDRESS (street, city, zone, county, state)\nsame\nNAME Laciell AND mawin 150 Rosewood Drive metaine fa\nADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nniece\nDATE OF BIRTH (Month,\nday\nyear)\nSingle\nMarried\nSeparated\nWidowed\nDivorced\n2/18/88\nYES\nNO\nWHAT LANGUAGES DO YOU SPEAK?\nHIGH SCHOOL GRADUATE\nfren eld\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nWestern Resume h.\nClanel and\n40-41\nCPH4\nPHN\nYES\nREGISTERED (State) fa\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nARE YOU CURRENTLY\nNO\nIN\nREGISTERED?\n9\n4\nNURSES' ASSOCIATION?\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nORGANIZATION Pubice BY WHOM Hearte EMPLOYED\nP where Heart\nNAME OF HOSPITAL OR\nFu. State Health\nnew CI/YY terricus STATE fa.\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nHEALTH good\nVOLUNTEER SERVICE\nthe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are willing and able\nto\nserve if called on within the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT 12 MONTHS\nN.O. Chaper\n1. Teach home\nYES\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nYES\nof disaster\nIn other communities\noffered, in preparation for service\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter cóm-\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?\nyes\nDATE >UNABLE TO wide SERVE, portuni GIVE MAJOR REASONS probubts my S helping IGNATURE is mything manim but discuster\nIF,\nYOUR VALUE 16 4 RED CROSS NURSE DEPENDS or YOUR ABILITY IN\nAND WILLINGIESS mm to SERVE AND YOUR PAITEPOLNESS\nKEEPING US INPORNED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONFAIRE AND REfURN If PRONPILY TO THE\nCOMMIFTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nN. O. CHAPTER\nNURSE RECRUITMENT\nCOMMITTEE\nAMERICAN RED CROSS\n78504M\n2127 PRYTANIA STREET\nFORM 1045 Rev. July 1945\nNPW ORLEANS 13, LA."
}