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FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
Red Cross
If you have changed your last name
Badge number 6072
since contacting us, please check here.
office: STaTe 8883
Name in full Tittman , anna Louise
Tel. No Home Whitehall
(last)
(first)
(middle)
If married, give maiden single
name
Date of birth 1884
4245
Marital status
single
Husband's name
(single, married, widowed, divorced)
Permanent
address R.J.Travis - 312 W. 114th St
Chicago,
Cook
Co
Ills.
(street)
(city)
(county)
(state)
Present address 25 Delaware P.I. Chicago, cook
IIIS
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
Give name and address of nearest relative or friend in the United States:
Mrs. R. J. Travis
3124 W. 114th St. Chicago Ills
Niece
(name)
(address) Morgan Park station
(relationship)
Are you employed in nursing at the present time? Yes
No
If employed, check the type of work you are doing and fill in below the title of your position and the name
and address of the agency or institution:
Institutional
Public Health
Industrial
Private Duty
Other
Placemont Nurses Coursel ing
Executive Director Nurse Placement Service
8 So. Michigan ave. Chicago Ills
If not employed, what type of nursing would you prefer to render?
IT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND
ANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX
AVAILABILITY FOR SERVICE WITH THE ARMED FORCES
Requirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She
may be single or married, but if married she must have no dependents under 14 years of age.
If eligible and not already in service with the armed forces, are you:
Immediately available?
Available in the near future?
and
age
(specify date)
Not available, for the following reason?
(specify)
Do you have any dependents under 14 years age? Yes
No
32/44
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes?
To
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
To serve overseas caring for civilians?
Have you ever served with the Red Cross in a disaster? Yes
No
If
yes, specify type of disaster Cyclone Charleston fees.
Drownings: - entimed Pience Pekin fees.
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"ocrText": "FORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nRed Cross\nIf you have changed your last name\nBadge number 6072\nsince contacting us, please check here.\noffice: STaTe 8883\nName in full Tittman , anna Louise\nTel. No Home Whitehall\n(last)\n(first)\n(middle)\nIf married, give maiden single\nname\nDate of birth 1884\n4245\nMarital status\nsingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent\naddress R.J.Travis - 312 W. 114th St\nChicago,\nCook\nCo\nIlls.\n(street)\n(city)\n(county)\n(state)\nPresent address 25 Delaware P.I. Chicago, cook\nIIIS\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\nMrs. R. J. Travis\n3124 W. 114th St. Chicago Ills\nNiece\n(name)\n(address) Morgan Park station\n(relationship)\nAre you employed in nursing at the present time? Yes\nNo\nIf employed, check the type of work you are doing and fill in below the title of your position and the name\nand address of the agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nPlacemont Nurses Coursel ing\nExecutive Director Nurse Placement Service\n8 So. Michigan ave. Chicago Ills\nIf not employed, what type of nursing would you prefer to render?\nIT IS IMPERATIVE THAT YOU READ CAREFULLY THE QUESTIONS BELOW AND\nANSWER BY PLACING A CHECK IN THE APPROPRIATE BOX\nAVAILABILITY FOR SERVICE WITH THE ARMED FORCES\nRequirements: For assignment to the Navy Nurse Corps, a Red Cross nurse must be physically fit, single, and under 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically fit and under 45. She\nmay be single or married, but if married she must have no dependents under 14 years of age.\nIf eligible and not already in service with the armed forces, are you:\nImmediately available?\nAvailable in the near future?\nand\nage\n(specify date)\nNot available, for the following reason?\n(specify)\nDo you have any dependents under 14 years age? Yes\nNo\n32/44\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes?\nTo\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\nTo serve overseas caring for civilians?\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nIf\nyes, specify type of disaster Cyclone Charleston fees.\nDrownings: - entimed Pience Pekin fees."
}