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FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
M
ANNUAL QUESTIONNAIRE-1944
Red Cross
If you have changed your last name
ar
Badge number 41,543
since contacting us, please check here.
Name
in full Ineseral marian Catherine
Tel. No. 2W 574
(last)
(first)
(middle)
If married, give maiden name
Date
of birth 12-10-1898
Marital status
single married,
Husband's name
(single, widowed, divorced)
Permanent address
(street)
(city)
Present address
Paia-Mani-TH. -
(county)
(state)
Baldivin (street) Hosp ycity)
(county)
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in, the United States:
Mrs.
(name) Estella Meseroll (address) manasquan NJ- (relationship) mother
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:
Institutional
Public Health
Industrial
Private Duty
Other
Staff nurce- O.C.D. assistant Wailuku to Chief mam nurse F.H.
If not employed, what type of nursing would you prefer to render?
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
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes ?
Now (week)
teaching Jan 3 classes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment
To serve overseas caring for civilians?
Have you ever served with the Red Cross in a disaster? Yes
So employed No
If yes, specify type of disaster
arsenal Explosion - Dones. nJ
I
Page data
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- Type
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- Media ID
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Document data
- ID
- 2661965
- Core
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- Type
- document
DTO data
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"ocrText": "O\n=\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nM\nANNUAL QUESTIONNAIRE-1944\nRed Cross\nIf you have changed your last name\nar\nBadge number 41,543\nsince contacting us, please check here.\nName\nin full Ineseral marian Catherine\nTel. No. 2W 574\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate\nof birth 12-10-1898\nMarital status\nsingle married,\nHusband's name\n(single, widowed, divorced)\nPermanent address\n(street)\n(city)\nPresent address\nPaia-Mani-TH. -\n(county)\n(state)\nBaldivin (street) Hosp ycity)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in, the United States:\nMrs.\n(name) Estella Meseroll (address) manasquan NJ- (relationship) mother\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:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nStaff nurce- O.C.D. assistant Wailuku to Chief mam nurse F.H.\nIf not employed, what type of nursing would you prefer to render?\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\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes ?\nNow (week)\nteaching Jan 3 classes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment\nTo serve overseas caring for civilians?\nHave you ever served with the Red Cross in a disaster? Yes\nSo employed No\nIf yes, specify type of disaster\narsenal Explosion - Dones. nJ\nI"
}