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Ealted m
# 2 card
juy
They
JAN 2 0 1944
FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
ari
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
If you have changed your last name
Red Badge Cross number 24635
since contacting us, please check here.
Name in full
mayo marian (first)
K
Tel. No. amiliville' 156195
K
(last)
(middle)
Date of birth February 19, 1890
a
If married, give maiden name
Single
+
Marital status
Husband's name
(single, married, widowed, divorced)
L
Permanent address
292 Marrick Rd, Amiliville
S.H.tate
(street)
(city)
(county)
(state)
n.y
le
-
Present address
same as above
(street)
(city)
(county)
(state)
to
Notify national headquarters immediately if you change your address.
5
Give name and address of nearest relative or friend in the United States:
Mrsheslic m Johns Merrick (address) Rd. Amilyville n.y
sister
(name)
(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:
Public Health
Private Duty
Other
Institutional Due to a Spinal Industrial injury I have been un able I am to do any
If not employed, what type of nursing would you prefer to render permanantly lame-
active work for the past four years.
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:
your
8.A
To teach Red Cross Home Nursing classes'
a
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment
01
To serve overseas caring for civilians?
Have you ever served with the Red Cross in a disaster? Yes
No
3
If yes, specify type of disaster
5
Page data
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- Type
- photo
- Media ID
- 04fcc7b747ba1262
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- unknown
Document data
- ID
- 2661909
- Core
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- Type
- document
DTO data
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"ocrText": "Ealted m\n# 2 card\njuy\nThey\nJAN 2 0 1944\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nari\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nIf you have changed your last name\nRed Badge Cross number 24635\nsince contacting us, please check here.\nName in full\nmayo marian (first)\nK\nTel. No. amiliville' 156195\nK\n(last)\n(middle)\nDate of birth February 19, 1890\na\nIf married, give maiden name\nSingle\n+\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nL\nPermanent address\n292 Marrick Rd, Amiliville\nS.H.tate\n(street)\n(city)\n(county)\n(state)\nn.y\nle\n-\nPresent address\nsame as above\n(street)\n(city)\n(county)\n(state)\nto\nNotify national headquarters immediately if you change your address.\n5\nGive name and address of nearest relative or friend in the United States:\nMrsheslic m Johns Merrick (address) Rd. Amilyville n.y\nsister\n(name)\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:\nPublic Health\nPrivate Duty\nOther\nInstitutional Due to a Spinal Industrial injury I have been un able I am to do any\nIf not employed, what type of nursing would you prefer to render permanantly lame-\nactive work for the past four years.\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:\nyour\n8.A\nTo teach Red Cross Home Nursing classes'\na\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment\n01\nTo serve overseas caring for civilians?\nHave you ever served with the Red Cross in a disaster? Yes\nNo\n3\nIf yes, specify type of disaster\n5"
}