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FORM 1045
REV. JAN 1941
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D. c.
Name in full
Raeph, (SURNAME) Ausaw (FIRST) Sherley (MIDDLE) Year of Birth 1918
Husband's name
Permanent
address 148,42 (STREET) 86th avenue, (CITY) Jamaica (COUNTY) L. D., Zenyork (STATE)
Probable address
for the next year american Red Cros-Harvard Hospital unit,
S
(STREET)
(CITY)
(COUNTY)
London
(STATE)
5
Telephone number
(EXCHANGE)
(NO.)
England
T
Give name and address of nearest relative or friend in United States:
Heuryw (NAME) Raepa-
father (RELATIONSHIP) 148 42 86th Care (ADDRESS) Jamaica n. 4.
ey
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
Columbia Centre
Public Health
Private duty
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
MAJOR RESPONSIBILITIES Adminis
Super
Teach-
General
Private
Other
of present employment tration
vision
ing
Staff
Duty
(specify)
IF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other
AVAILABILITY the american Red Cross. Harvard Hospital leviet for
not available Have accepted appoint ment (WRITE IN) with
At the present time would you
overseas duty in England
Date
accept assignment to the Army? Yes
No
Navy? Yes
No
available
In case of a war emergency would you
accept assignment to the Army? Yes
No
Navy? Yes
No
If not now employed would you
accept nursing work? Full-time? Yes
No
Part-time? Yes
No
In your own community? Yes
No
Elsewhere? Yes
No
Would you be interested in teaching classes in Home Hygiene and Care of the Sick? no
Present physical condition Excellent
Badge No. 82230
Current date
2/25/H
8
Name of Committee MANHATT AN
N
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enrollment will be removed from our active files.
U
3
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"ocrText": "al\nFORM 1045\nREV. JAN 1941\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D. c.\nName in full\nRaeph, (SURNAME) Ausaw (FIRST) Sherley (MIDDLE) Year of Birth 1918\nHusband's name\nPermanent\naddress 148,42 (STREET) 86th avenue, (CITY) Jamaica (COUNTY) L. D., Zenyork (STATE)\nProbable address\nfor the next year american Red Cros-Harvard Hospital unit,\nS\n(STREET)\n(CITY)\n(COUNTY)\nLondon\n(STATE)\n5\nTelephone number\n(EXCHANGE)\n(NO.)\nEngland\nT\nGive name and address of nearest relative or friend in United States:\nHeuryw (NAME) Raepa-\nfather (RELATIONSHIP) 148 42 86th Care (ADDRESS) Jamaica n. 4.\ney\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nColumbia Centre\nPublic Health\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nMAJOR RESPONSIBILITIES Adminis\nSuper\nTeach-\nGeneral\nPrivate\nOther\nof present employment tration\nvision\ning\nStaff\nDuty\n(specify)\nIF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther\nAVAILABILITY the american Red Cross. Harvard Hospital leviet for\nnot available Have accepted appoint ment (WRITE IN) with\nAt the present time would you\noverseas duty in England\nDate\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable\nIn case of a war emergency would you\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\nIf not now employed would you\naccept nursing work? Full-time? Yes\nNo\nPart-time? Yes\nNo\nIn your own community? Yes\nNo\nElsewhere? Yes\nNo\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick? no\nPresent physical condition Excellent\nBadge No. 82230\nCurrent date\n2/25/H\n8\nName of Committee MANHATT AN\nN\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enrollment will be removed from our active files.\nU\n3"
}