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FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
Isplaydo
eveiled
eb
Red Cross
Badge number H.D.-11,911
If you have changed your last name
since contacting us, please check here.
a
in full Mumma Reba Elizabeth
11
Name
Tel. No. 91492
(last)
(first)
(middle)
Date of birth June 20 1916
E
If married, give maiden name
Marital status
Single
but
=
Husband's name
(single, married, widowed, divorced)
2
Permanent
address 524 evestview Rd. Columbus , Franklin Ohio
(street)
(city)
Present address 1310 Punahou ' (street) St Honolulu , (city) T.H (county) C/o Polio (state) Hospital
a
(county)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
Mr. Frank B. Mumma 524 (vestview Rd. Columbus Ohio (father)
(name)
(address)
(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:
Institutional
Public Health
Industrial
Private Duty
Other
Polie Emergency Hospital
1310 Punahow st Honolulu T.T.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 ? Jevuing cibiliaus overseas c the Office of Guilian
(specify) Defeuse of T.H
Do you have any dependents under 14 years of age? Yes
No
I
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
D
To teach Red Cross Home Nursing classes?
To teach volunteer nurse's aides?
e
To take a Red Cross emergency assignment?
To serve overseas caring for civilians ?
yes
Have you ever served with the Red Cross in a disaster Yes
No
smaK)
3/16/ xx
bell
If yes, specify type of disaster
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"ocrText": "1\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nIsplaydo\neveiled\neb\nRed Cross\nBadge number H.D.-11,911\nIf you have changed your last name\nsince contacting us, please check here.\na\nin full Mumma Reba Elizabeth\n11\nName\nTel. No. 91492\n(last)\n(first)\n(middle)\nDate of birth June 20 1916\nE\nIf married, give maiden name\nMarital status\nSingle\nbut\n=\nHusband's name\n(single, married, widowed, divorced)\n2\nPermanent\naddress 524 evestview Rd. Columbus , Franklin Ohio\n(street)\n(city)\nPresent address 1310 Punahou ' (street) St Honolulu , (city) T.H (county) C/o Polio (state) Hospital\na\n(county)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\nMr. Frank B. Mumma 524 (vestview Rd. Columbus Ohio (father)\n(name)\n(address)\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:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nPolie Emergency Hospital\n1310 Punahow st Honolulu T.T.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 ? Jevuing cibiliaus overseas c the Office of Guilian\n(specify) Defeuse of T.H\nDo you have any dependents under 14 years of age? Yes\nNo\nI\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nD\nTo teach Red Cross Home Nursing classes?\nTo teach volunteer nurse's aides?\ne\nTo take a Red Cross emergency assignment?\nTo serve overseas caring for civilians ?\nyes\nHave you ever served with the Red Cross in a disaster Yes\nNo\nsmaK)\n3/16/ xx\nbell\nIf yes, specify type of disaster"
}