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FORM 1045
AMERICAN RED CROSS
REV. OCT. 1943
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
Red Cross
If you have changed your last name
Badge number 13212
since contacting us, please check here.
Name in full
Webb BLANche FRANKlIN
Tel. No. 50837
(last)
(first)
(middle)
If married, give maiden name
Marital status
sungle
Date of birth June 11, 1885
Husband's name
(single, married, widowed, divorced)
Permanent address 3312 (street) Studely an (city) Binaneth
Norfach
Va
(county)
(state)
Present address
same
(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:
L.W.WrG (name) 6- 1018 magnolia (address) Are., Norfact Va
(Berter)
(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
Retered m 1940
after 25 your me Publes Hewete Eup in P H for years
If
not employed, what type of nursing would you prefer to render? (not week lungh )
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?
(specify date)
Not available, for the following reason ? over
age
(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?
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 As a Red Cerro suppensing nurse in 1920
anguyend Emergency Hospital (few duy strue my
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"ocrText": "FORM 1045\nAMERICAN RED CROSS\nREV. OCT. 1943\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nRed Cross\nIf you have changed your last name\nBadge number 13212\nsince contacting us, please check here.\nName in full\nWebb BLANche FRANKlIN\nTel. No. 50837\n(last)\n(first)\n(middle)\nIf married, give maiden name\nMarital status\nsungle\nDate of birth June 11, 1885\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 3312 (street) Studely an (city) Binaneth\nNorfach\nVa\n(county)\n(state)\nPresent address\nsame\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:\nL.W.WrG (name) 6- 1018 magnolia (address) Are., Norfact Va\n(Berter)\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\nRetered m 1940\nafter 25 your me Publes Hewete Eup in P H for years\nIf\nnot employed, what type of nursing would you prefer to render? (not week lungh )\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?\n(specify date)\nNot available, for the following reason ? over\nage\n(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?\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 yes, specify type of disaster As a Red Cerro suppensing nurse in 1920\nanguyend Emergency Hospital (few duy strue my"
}