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N
A.R.C. MAIL ROOM
RECEIV FBB 20 1940
FORM 1045
AMERICAN RED CROSS
REV. DEC. 1939
OUESTIONNAIRES DESTROYES
NATIONAL HEADQUARTERS APR 1 8 1940
WASHINGTON, D. C. Refexrod to.
Name in full
Muni
Christine
mercedes
S
(SURNAME)
(FIRST)
(MIDDLE)
e
Husband s name
Permanent
address 134 (STREET) East 1914St (CITY) newyork (COUNTY) City (STATE) n.y
Probable
for the
next address year Alunker (STREET) College of hursing Tokyo (COUNTY), Japan (STATE)
Telephone number
(EXCHANGE)
(NO.)
Nearest relative or friend in United States, through whom you may be communicated with in
(Miss) Florence Johnson
an emergency:
Friend
(NAME)
134 (STREET) East 19th St new (CITY) your City (STATE) n.y.
PRESENT WORK (check below)
Name of agency or institution with which employed
-
Institutional
National Council Episcopal Church
Public Health
Director P.H. nursing Shukes Tokyo Japas
Private duty
Other (write in)
Government Service: Army
U.S.P.H.Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
IF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other (write in)
Would you respond to an emergency call in event of local or national emergency, such as
epidemic, flood, war, etc.
yes
(Granted of course that you could be released from present employment)
Present physical condition
Excellent.
Would you be interested in teaching classes in Home Hygiene and Care of the Sick? yes.
Are you a member of the American Nurses' Association?
yes
g
If not, why have you allowed your membership to lapse?
J
Badge No. 33922
Current date March 281940
NATIONAL MEADQUARTERS
Name of Committee
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enroilment will be removed from our active files.
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Document data
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- Core
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"ocrText": "N\nA.R.C. MAIL ROOM\nRECEIV FBB 20 1940\nFORM 1045\nAMERICAN RED CROSS\nREV. DEC. 1939\nOUESTIONNAIRES DESTROYES\nNATIONAL HEADQUARTERS APR 1 8 1940\nWASHINGTON, D. C. Refexrod to.\nName in full\nMuni\nChristine\nmercedes\nS\n(SURNAME)\n(FIRST)\n(MIDDLE)\ne\nHusband s name\nPermanent\naddress 134 (STREET) East 1914St (CITY) newyork (COUNTY) City (STATE) n.y\nProbable\nfor the\nnext address year Alunker (STREET) College of hursing Tokyo (COUNTY), Japan (STATE)\nTelephone number\n(EXCHANGE)\n(NO.)\nNearest relative or friend in United States, through whom you may be communicated with in\n(Miss) Florence Johnson\nan emergency:\nFriend\n(NAME)\n134 (STREET) East 19th St new (CITY) your City (STATE) n.y.\nPRESENT WORK (check below)\nName of agency or institution with which employed\n-\nInstitutional\nNational Council Episcopal Church\nPublic Health\nDirector P.H. nursing Shukes Tokyo Japas\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H.Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nIF NOT ACTIVE IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther (write in)\nWould you respond to an emergency call in event of local or national emergency, such as\nepidemic, flood, war, etc.\nyes\n(Granted of course that you could be released from present employment)\nPresent physical condition\nExcellent.\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick? yes.\nAre you a member of the American Nurses' Association?\nyes\ng\nIf not, why have you allowed your membership to lapse?\nJ\nBadge No. 33922\nCurrent date March 281940\nNATIONAL MEADQUARTERS\nName of Committee\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enroilment will be removed from our active files."
}