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FORM 1045
REV. JAN 1941
AMERICAN RED CROSS
NATIONAL HEADQUARTERS
WASHINGTON, D.
Name in full (SURNAME) amie (FIRST) Garle (MIDDLE)
Year of Birth 1885
Husband's name
Permanent address (STREET) Ferantlin Durupike (CITY) horth (COUNTY) Bergm (STATE)
Ramery,
Probable address
Same as above
for the next year
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number Ramoly (EXCHANGE) 194
(NO.)
Give name and address of nearest relative or friend in United States:
Ins (NAME) H.a.asnold, Sister, (RELATIONSHIP) 53rdgewood.Com, youkers, (ADDRESS) R.Y.
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
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
(AJOR 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
Othere Feoreign (WRITE Envergency IN)
AVAILABILITY
At the present time would you
Date
a
accept assignment to the Army? Yes
No
Navy? Yes
No
available
A
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 teaching Hygiene and Care of the Sick? yes
in classes in Home
Present physical condition Excellent
Badge No. 15,504
Current date Heb.21,1941
Name of Committee Jersey City Local n J.
C
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.
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"ocrText": "FORM 1045\nREV. JAN 1941\nAMERICAN RED CROSS\nNATIONAL HEADQUARTERS\nWASHINGTON, D.\nName in full (SURNAME) amie (FIRST) Garle (MIDDLE)\nYear of Birth 1885\nHusband's name\nPermanent address (STREET) Ferantlin Durupike (CITY) horth (COUNTY) Bergm (STATE)\nRamery,\nProbable address\nSame as above\nfor the next year\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number Ramoly (EXCHANGE) 194\n(NO.)\nGive name and address of nearest relative or friend in United States:\nIns (NAME) H.a.asnold, Sister, (RELATIONSHIP) 53rdgewood.Com, youkers, (ADDRESS) R.Y.\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\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\n(AJOR RESPONSIBILITIES Adminis\nSuper\nTeach\nGeneral\nPrivate\nOther\nof present employment\ntration\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\nOthere Feoreign (WRITE Envergency IN)\nAVAILABILITY\nAt the present time would you\nDate\na\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable\nA\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 teaching Hygiene and Care of the Sick? yes\nin classes in Home\nPresent physical condition Excellent\nBadge No. 15,504\nCurrent date Heb.21,1941\nName of Committee Jersey City Local n J.\nC\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."
}