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FN 1/11/45
FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
101
If you have changed your last name
Red Cross
since contacting us, please check here.
Badge number 75900
Name in
full WAltERS
RosiNA
MAY
Tel. No. MAiN 1757
(last)
(first)
(middle)
Date of birth 12- 12-07
If married, give maiden name
sdi
SINGLE
Husband's name
Marital status
Permanent address 425 W, STEpheuson (city) FREEPORT, (county) Stephenson, ILL (state)
(single, married, widowed, divorced)
address 310 W. Everett Dixon
PART-Time
(street)
wee
ILL
Present
(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:
FRANK WAlteRS 408W, Jefferson WheaTon, Ill
BRo.
(name)
(address)
(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:
Public Health
Industrial
Private Duty
Other
Institutional DisTRicT Supervising NuRse, STATe Ill Dept OF Public Health
Division OF HURSING springfield,
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, fit single, and under and under 45. She 40.
For assignment to the Army Nurse Corps, a Red Cross nurse must be physically of
may be single or married, but if married she must have no dependents under 14 years age.
If eligible and not already in service with the armed forces, are you:
Immediately available?
Available in the near future?
(specify date)
Not available, for the following reason ? OCCUPATIONAL Classification (specify)
Do you have any dependents under 14 years of age? Yes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
If qualified and not already doing so, will you be available:
To teach Red Cross Home Nursing classes? yes
To teach volunteer nurse's aides?
To take a Red Cross emergency assignment?
To serve overseas caring for civilians?
If yes, specify type of disaster CoopeRATively iN present AReA(ToRNAdo 1944)
Have you ever served with the Red Cross in a disaster? Yes
No
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"ocrText": "FN 1/11/45\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\n101\nIf you have changed your last name\nRed Cross\nsince contacting us, please check here.\nBadge number 75900\nName in\nfull WAltERS\nRosiNA\nMAY\nTel. No. MAiN 1757\n(last)\n(first)\n(middle)\nDate of birth 12- 12-07\nIf married, give maiden name\nsdi\nSINGLE\nHusband's name\nMarital status\nPermanent address 425 W, STEpheuson (city) FREEPORT, (county) Stephenson, ILL (state)\n(single, married, widowed, divorced)\naddress 310 W. Everett Dixon\nPART-Time\n(street)\nwee\nILL\nPresent\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:\nFRANK WAlteRS 408W, Jefferson WheaTon, Ill\nBRo.\n(name)\n(address)\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:\nPublic Health\nIndustrial\nPrivate Duty\nOther\nInstitutional DisTRicT Supervising NuRse, STATe Ill Dept OF Public Health\nDivision OF HURSING springfield,\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, fit single, and under and under 45. She 40.\nFor assignment to the Army Nurse Corps, a Red Cross nurse must be physically of\nmay be single or married, but if married she must have no dependents under 14 years age.\nIf eligible and not already in service with the armed forces, are you:\nImmediately available?\nAvailable in the near future?\n(specify date)\nNot available, for the following reason ? OCCUPATIONAL Classification (specify)\nDo you have any dependents under 14 years of age? Yes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\nIf qualified and not already doing so, will you be available:\nTo teach Red Cross Home Nursing classes? yes\nTo teach volunteer nurse's aides?\nTo take a Red Cross emergency assignment?\nTo serve overseas caring for civilians?\nIf yes, specify type of disaster CoopeRATively iN present AReA(ToRNAdo 1944)\nHave you ever served with the Red Cross in a disaster? Yes\nNo"
}