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RED CROSS BADGE NUMBER
AMERICAN RED CROSS
11,891
NURSING SERVICES
MILITARY SERIAL NUMBER
ANNUAL QUESTIONNAIRE - 1945
CHECK IF YOUR LAST NAME HAS CHANGED
NAME (Last, first, middle)
TELEPHONE NO.
Smythe Eva Louise
Hack. 2- 6096 W.
IF MARRIED, GIVE MAIDEN NAME
HUSBAND'S NAME
no
PERMANENT ADDRESS (Street, city, zone, county, state)
PRESENT ADDRESS (Street, city, zone, county, state)
40 Passaic St Bergen - new Jersey
NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE STATES
40 UNITED Passaic - Bergen - RELATIONSHIP new Jersey
mrs ArthurT Robinson-174 myrtle St.newBeaford-mass
sister
DATE OF BIRTH (Month, day, year)
m ay30-1878
Single
yes
Married
-
Separated
-
Widowed
-
Divorced
-
WHAT LANGUAGES DO YOU SPEAK?
YES
NO
HIGH SCHOOL GRADUATE
NAME OF COLLEGE OR
English
DEGREE OR
UNIVERSITY ATTENDED
LOCATION
INCLUSIVE DATES
DIPLOMA
MAJOR
Rutgers
new Brunswick-h.
yrs. P.H.comucions
Newark uneverity newark- n.J
00 Parent child,
Relationship
h.y.u. 7
newyork
Racial Contribution
11
to americaCullun
ARE YOU CURRENTLY
YES
NO
REGISTERED IN (State)
ARE YOU CURRENTLY A MEMBER OF THE AMERICAN
YES
NO
REGISTERED?
x
harrJerseysmasa
NURSES' ASSOCIATION?
x
PRESENT EMPLOYMENT If not employed, check
POSITION TITLE (H.N., P.D., inst., staff nurse, etc.) St Dept Health.
SERVICE (Medicine, surgery, etc.)
District Supervisor- Bureau maternal+child Health
NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED
n J.State Dept. of Health. Bureau maternal ChiedH
CITY
STATE
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
Central Berain Chabter Hackersach n. J.
1. Teach home
YES
NO
Attend an Instructors' training program, 1f offered. (Funds are available for
YES
NO
nursing classes
training home nursing instructors. See local chapter.)
2. Serve in case
YES
NO
only in home community
Attend disaster institutes, if
YES
NO
of disaster
In other communities
offered, in preparation for service
3. Teach nurse's
YES
NO
4. Accept membership on chapter com-
YES
NO
5. Assist with other chapter
YES
NO
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
you will be able to serve at some time in the future?
IF UNABLE TO SERVE, GIVE MAJOR REASONS
Have a full time position
DATE
Sept. 5-1945
SIGNATURE
Era L.Singthe R.Y.
YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFULNESS IN
KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE
COMMITTEE NAMED BELOW.
ATTENTION
C
Fill in committee name and address before sending questionnaire to nurse.
SECRETARY
AMERICAN NATIONALRED CROSS
NURSE RECRUITMENT
CENTRAL BERGEN CHAPTER
9/18/45
COMMITTEE
393 Maw Street
78504M
HACKENSACK, N. J.
FORM 1045 Rev. July 1945
Page data
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Document data
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- Core
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"ocrText": "RED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n11,891\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nNAME (Last, first, middle)\nTELEPHONE NO.\nSmythe Eva Louise\nHack. 2- 6096 W.\nIF MARRIED, GIVE MAIDEN NAME\nHUSBAND'S NAME\nno\nPERMANENT ADDRESS (Street, city, zone, county, state)\nPRESENT ADDRESS (Street, city, zone, county, state)\n40 Passaic St Bergen - new Jersey\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE STATES\n40 UNITED Passaic - Bergen - RELATIONSHIP new Jersey\nmrs ArthurT Robinson-174 myrtle St.newBeaford-mass\nsister\nDATE OF BIRTH (Month, day, year)\nm ay30-1878\nSingle\nyes\nMarried\n-\nSeparated\n-\nWidowed\n-\nDivorced\n-\nWHAT LANGUAGES DO YOU SPEAK?\nYES\nNO\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nEnglish\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nRutgers\nnew Brunswick-h.\nyrs. P.H.comucions\nNewark uneverity newark- n.J\n00 Parent child,\nRelationship\nh.y.u. 7\nnewyork\nRacial Contribution\n11\nto americaCullun\nARE YOU CURRENTLY\nYES\nNO\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nREGISTERED?\nx\nharrJerseysmasa\nNURSES' ASSOCIATION?\nx\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.) St Dept Health.\nSERVICE (Medicine, surgery, etc.)\nDistrict Supervisor- Bureau maternal+child Health\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nn J.State Dept. of Health. Bureau maternal ChiedH\nCITY\nSTATE\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\nCentral Berain Chabter Hackersach n. J.\n1. Teach home\nYES\nNO\nAttend an Instructors' training program, 1f offered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nNO\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nof disaster\nIn other communities\noffered, in preparation for service\n3. Teach nurse's\nYES\nNO\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\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\nyou will be able to serve at some time in the future?\nIF UNABLE TO SERVE, GIVE MAJOR REASONS\nHave a full time position\nDATE\nSept. 5-1945\nSIGNATURE\nEra L.Singthe R.Y.\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR FAITHFULNESS IN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONNAIRE AND RETURN IT PROMPTLY TO THE\nCOMMITTEE NAMED BELOW.\nATTENTION\nC\nFill in committee name and address before sending questionnaire to nurse.\nSECRETARY\nAMERICAN NATIONALRED CROSS\nNURSE RECRUITMENT\nCENTRAL BERGEN CHAPTER\n9/18/45\nCOMMITTEE\n393 Maw Street\n78504M\nHACKENSACK, N. J.\nFORM 1045 Rev. July 1945"
}