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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
33972
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
+1
NAME (Last, first, middle)
TELEPHONE NO.
5
nuno Christine m.
R14-6531
IF MARRIED, GIVE MAIDEN NAME
HUSBAND'S NAME
PERMANENT ADDRESS (Street city, zone, county, state)
015-737 35. n.4. City
M
PRESENT ADDRESS (Street, city, zone, county, state)
215 873151 n.y.c.
(6
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES
RELATIONSHIP
Jas nuno Brother mess am Johnson 15-373151
Brother : mind
s
C
DATE OF BIRTH (Month, day, year)
Single
W1 dowed
Divorçed
lug 11 1892
Married
Separated
YES
NO
WHAT LANGUAGES DO YOU SPEAK?
HIGH SCHOOL GRADUATE
4
NAME OF COLLEGE OR
UNIVERSITY ATTENDED
Teachers Culley FION Aye
DEGREE OR
INCLUSIVE DATES
DIPLOMA
MAJOR
Maukasnitt d.9
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
n.y.
NURSES' ASSOCIATION?
REGISTERED?
PRESENT EMPLOYMENT If not employed, check
SERVICE (Medicine, surgery, etc.)
POSITION am TITLE (H.N., P.D., hos inst., staff hursury nurse, etc.) service
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
CITY
STATE
am red hro
HEALTH
IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY
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
1. Teach home
YES
No
Attend an instructors' training program, if offered. (Funds are available for
YES
NO
\
nursing classes
training home nursing instructors. See local chapter.)
Attend disaster institutes, 1f
KES
2. Serve in case
YES
only in home community
x
In other communities
offered, in preparation for service
of disaster
NO
4. Accept membership on chapter cóm-
YES
VO
5. Assist with other chapter
YES
NO
3. Teach nurse's
YES
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
w
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE MAJOR REASONS-
IGNATURE
Christine M tune
I
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS\ IN
DATE aug 19 1945
J
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN If PROMPTLY TO
THE
2
COMMITTEE NAMED BELOW.
ATTENTION
Fill in committee name and address before sending questionnaire to nurse.
NURSE RECRUITMENT CENTER
SECRETARY
2 EAST 37TH STREET
NURSE RECRUITMENT
NEW YORK 16, N. Y.
COMMITTEE
FORM 1045 Rev. July 1945
78504M
10 %
2
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"ocrText": "N\nof\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n33972\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\n+1\nNAME (Last, first, middle)\nTELEPHONE NO.\n5\nnuno Christine m.\nR14-6531\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nPERMANENT ADDRESS (Street city, zone, county, state)\n015-737 35. n.4. City\nM\nPRESENT ADDRESS (Street, city, zone, county, state)\n215 873151 n.y.c.\n(6\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nRELATIONSHIP\nJas nuno Brother mess am Johnson 15-373151\nBrother : mind\ns\nC\nDATE OF BIRTH (Month, day, year)\nSingle\nW1 dowed\nDivorçed\nlug 11 1892\nMarried\nSeparated\nYES\nNO\nWHAT LANGUAGES DO YOU SPEAK?\nHIGH SCHOOL GRADUATE\n4\nNAME OF COLLEGE OR\nUNIVERSITY ATTENDED\nTeachers Culley FION Aye\nDEGREE OR\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nMaukasnitt d.9\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nn.y.\nNURSES' ASSOCIATION?\nREGISTERED?\nPRESENT EMPLOYMENT If not employed, check\nSERVICE (Medicine, surgery, etc.)\nPOSITION am TITLE (H.N., P.D., hos inst., staff hursury nurse, etc.) service\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nam red hro\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\ngood\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 to\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\n1. Teach home\nYES\nNo\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\n\\\nnursing classes\ntraining home nursing instructors. See local chapter.)\nAttend disaster institutes, 1f\nKES\n2. Serve in case\nYES\nonly in home community\nx\nIn other communities\noffered, in preparation for service\nof disaster\nNO\n4. Accept membership on chapter cóm-\nYES\nVO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\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 YES\nNo\nw\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS-\nIGNATURE\nChristine M tune\nI\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHPOLNESS\\ IN\nDATE aug 19 1945\nJ\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN If PROMPTLY TO\nTHE\n2\nCOMMITTEE NAMED BELOW.\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nNURSE RECRUITMENT CENTER\nSECRETARY\n2 EAST 37TH STREET\nNURSE RECRUITMENT\nNEW YORK 16, N. Y.\nCOMMITTEE\nFORM 1045 Rev. July 1945\n78504M\n10 %\n2"
}