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Form 1045 Rev. Nov. 1941 AMERICAN RED CROSS NURSING SERVICE 12 Verys Name in full Sanythie (last) Era (first) Lenise (middle) Tel. No. Hackersach2-6096 W If married, give maiden name Year of birth 1878 Marital status Husband's name (single, married, widowed, divorced) Permanent address 40 Passaic (street) St. Hackusack (city) Burgen (county) (state) transferse Probable address for the next year 40 Passaic (street) St Hacksusack (city) (county) Bergen (state) Give name and address of nearest relative or friend in United States: miss (name) grace m. millor-Friend (relationship) 4 (address) Are you employed in nursing at the present time? Yes No PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed Institutional Public health h. J. State Dept. of Horalth -Burrau maternals bhild Herattle Industrial Private duty Other (write in) Government Service: Army, Regular Navy, Regular Veterans Administration Reserve Reserve Children's Bureau U.S.P.H. Service U.S. Indian Service MAJOR RESPONSIBILITIES Administration Teaching Private duty of present employment Supervision General Staff Other (specify) How many years did you attend HIGH SCHOOL? One Two Three Four Graduated Yes No SINCE GRADUATION FROM YOUR SCHOOL OF NURSING have you ever had- 1. A postgraduate course or experience in any of the following special services? Postgraduate course Experience in hospital in a hospital or public health field (at least 3 months) (at least 6 months) Communicable disease nursing (include Tbc) Psychiatric Nursing Operating room Anaesthesia Public health nursing 2. Have you taken any courses in a college or university? Less than One Two Three Four Bachelor's Master's P.H.D. Certificate in *one year year years years years degree degree degree Public Health In what major field was above study ? Public Heralth, bhild guidance trantal Hygrame What languages, other than English, do you speak? noue * Academic year (OVER)

Page data

Page
14
Source index
0
Type
photo
Media ID
ee63d6f185a038f5
Size
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2662280
Core
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Type
document
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Document identity
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    "coverageEndDate": {
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        "logicalDate": "1945-09-05",
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Page context
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    "ocrText": "Form 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\n12\nVerys\nName in full Sanythie (last) Era (first) Lenise (middle)\nTel. No. Hackersach2-6096\nW\nIf married, give maiden name\nYear of birth 1878\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 40 Passaic (street) St. Hackusack (city) Burgen (county) (state)\ntransferse\nProbable address\nfor the next\nyear 40 Passaic (street) St Hacksusack (city) (county) Bergen (state)\nGive name and address of nearest relative or friend in United States:\nmiss (name) grace m. millor-Friend (relationship) 4 (address)\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nh. J. State Dept. of Horalth -Burrau maternals bhild Herattle\nIndustrial\nPrivate duty\nOther (write in)\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n*one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nIn what major field was above study ? Public Heralth, bhild guidance trantal Hygrame\nWhat languages, other than English, do you speak? noue\n* Academic year\n(OVER)"
}