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M
Hawair Unit - -Ret to were amick
Confidential
FORM 1219
REV. JUNE 1942
Please return
AMERICAN RED CROSS
APPLICATION FOR EMPLOYMENT - NURSING PERSONNEL
Feft
I. PERSONAL
Name in full Miss Reba Elizabeth Mumma
Badge (No.
(H.D. 11,911
(MISS OR MRS.)
(IF MARRIED, GIVE MAIDEN NAME ALSO)
Not enrolled
Present address 2136 Fulton St. Apt 4 Toledo llio
Tel. No. Ma. 8593
(STREET)
(CITY)
(STATE)
Permanent address 1474 Neil Avenue, Columbus this
Tel. No. Un 7361
(STREET)
(CITY)
(STATE)
Citizenship yes
Color white
Place of birth Reynn this
2nd
Present position staff nurse - (1500 years 1(1620 sincrease).) year Date of birth June 2.0 1916
(TITLE)
(SALARY)
Toledo District Nurse Assin 1903 Mouroe St. Toledo this
Single
Widowed
(ORGANIZATION)
(ADDRESS)
Married
Divorced
II. PROFESSIONAL STATUS
States registered ahio
Current registration yes Tho - 33317
To what professional organizations you belong? Ohio State university Hospital
do
Registration with this State nurses Dist #9 funding
If not an enrolled Red Cross nurse, has your application for enrollment been submitted to
your Local Committee Red Cross Nursing Service? (NOT chapter committee)
When and to whom?
III. EDUCATION
1. Prior to entering school of nursing:
Name
City and State Dates Diploma-Degree
Major
High School North High School
Columbus. Ohio
1930-1933
yes.
Acadeuise Course
Normal School
University this tote University
Columbus, lluin
1936-1939
Other
2. School of nursing from) dhio State University (NAME) Hospital Colume lhos
which you graduated)
(CITY)
(STATE)
Length of course
5 years
3 years
(Specify other)
Date completed Dec 19,1941
3. Undergraduate affiliations:
Hospital or Organization
City and State
Clinical Specialty No. Months
(1) Instructive District NurseAsin
Columbus, this
Public Health
(2)
(3)
I
4. Postgraduate clinical courses: (Do not include academic work or employment.)
Hospital or Organization
City and State
Clinical Specialty
Dates
D
(1)
(2)
(3)
5. Academic study since graduation from school of nursing:
College or University
City and State
Academic years
No. Points
(1)
(2)
(3)
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"ocrText": "M\nHawair Unit - -Ret to were amick\nConfidential\nFORM 1219\nREV. JUNE 1942\nPlease return\nAMERICAN RED CROSS\nAPPLICATION FOR EMPLOYMENT - NURSING PERSONNEL\nFeft\nI. PERSONAL\nName in full Miss Reba Elizabeth Mumma\nBadge (No.\n(H.D. 11,911\n(MISS OR MRS.)\n(IF MARRIED, GIVE MAIDEN NAME ALSO)\nNot enrolled\nPresent address 2136 Fulton St. Apt 4 Toledo llio\nTel. No. Ma. 8593\n(STREET)\n(CITY)\n(STATE)\nPermanent address 1474 Neil Avenue, Columbus this\nTel. No. Un 7361\n(STREET)\n(CITY)\n(STATE)\nCitizenship yes\nColor white\nPlace of birth Reynn this\n2nd\nPresent position staff nurse - (1500 years 1(1620 sincrease).) year Date of birth June 2.0 1916\n(TITLE)\n(SALARY)\nToledo District Nurse Assin 1903 Mouroe St. Toledo this\nSingle\nWidowed\n(ORGANIZATION)\n(ADDRESS)\nMarried\nDivorced\nII. PROFESSIONAL STATUS\nStates registered ahio\nCurrent registration yes Tho - 33317\nTo what professional organizations you belong? Ohio State university Hospital\ndo\nRegistration with this State nurses Dist #9 funding\nIf not an enrolled Red Cross nurse, has your application for enrollment been submitted to\nyour Local Committee Red Cross Nursing Service? (NOT chapter committee)\nWhen and to whom?\nIII. EDUCATION\n1. Prior to entering school of nursing:\nName\nCity and State Dates Diploma-Degree\nMajor\nHigh School North High School\nColumbus. Ohio\n1930-1933\nyes.\nAcadeuise Course\nNormal School\nUniversity this tote University\nColumbus, lluin\n1936-1939\nOther\n2. School of nursing from) dhio State University (NAME) Hospital Colume lhos\nwhich you graduated)\n(CITY)\n(STATE)\nLength of course\n5 years\n3 years\n(Specify other)\nDate completed Dec 19,1941\n3. Undergraduate affiliations:\nHospital or Organization\nCity and State\nClinical Specialty No. Months\n(1) Instructive District NurseAsin\nColumbus, this\nPublic Health\n(2)\n(3)\nI\n4. Postgraduate clinical courses: (Do not include academic work or employment.)\nHospital or Organization\nCity and State\nClinical Specialty\nDates\nD\n(1)\n(2)\n(3)\n5. Academic study since graduation from school of nursing:\nCollege or University\nCity and State\nAcademic years\nNo. Points\n(1)\n(2)\n(3)"
}