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Shebaygan Form 1045 Rev. Nov. 1942 AMERICAN RED CROSS NURSING SERVICE 2 - D.C. If you have changed your last name since contacting us, please check here. Name in full Wilson (last) Harriet- (first) Olga (middle) Tel. No. 519- If married, give maiden name Date of birth Oct 25/78. Marital status. Husband's name (single, Permanent address (street) will married, widowed, St divorced) Plymouth, (city) (county) Lo. (state) Wise Probable address for the next year above address - (street) (city) (county) (state) Give name and address of nearest relative or friend in United States: Hildegard (name) Wilson Sicter above address- (relationship) (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 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) If not employed, what type of nursing would you prefer to render? How many years did you attend HIGH SCHOOL? One Two Three Four Graduated Yes No Before entering training, how many years did you attend COLLEGE? Did you have a five-year course granting bachelor's degree? AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have- Postgraduate course in a hospital Experience in hospital 1. A postgraduate course or experience in any of the following services? (at least 3 months) (at least 6 months) Communicable disease nursing (include tuberculosis) Psychiatric nursing Operating room Anaesthesia ausucchisia ways drof mithod at mays clinic Rochester min 2. Have you had any courses in a college or university? Less than One Two Three Four Bachelor's Master's Ph.D. M. D. one academic year year years years years degree degree degree degree In what major field was above study? 3. Training and experience in the public health field: Postgraduate 4 months or more Certificate Degree Experience 6 months Have you ever held a position as an air hostess? Yes No How long? Have you ever had any other air experience? Yes No Specify I served over was in Frause in world Iat Base 82 (OVER) Have here doing prinate-duty since except for a 2 year Hept supt. Pacilitier. as also

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Page
11
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0
Type
photo
Media ID
fce5776590fd7527
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2662491
Core
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Type
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Context sent to Scholar

Document identity
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Document source extras
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Page context
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    "ocrText": "Shebaygan\nForm 1045\nRev. Nov. 1942\nAMERICAN RED CROSS\nNURSING SERVICE\n2 - D.C.\nIf you have changed your last name since\ncontacting us, please check here.\nName in full Wilson (last) Harriet- (first) Olga (middle)\nTel. No. 519-\nIf married, give maiden name\nDate of birth Oct 25/78.\nMarital status.\nHusband's name\n(single,\nPermanent address\n(street) will married, widowed, St divorced) Plymouth, (city) (county) Lo. (state) Wise\nProbable address\nfor the next year\nabove address -\n(street)\n(city)\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nHildegard (name) Wilson\nSicter\nabove address-\n(relationship)\n(address)\nAre you employed in nursing at the present time?\nYes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\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)\nIf not employed, what type of nursing would you prefer to render?\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nBefore entering training, how many years did you attend COLLEGE?\nDid you have a five-year course granting bachelor's degree?\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-\nPostgraduate course\nin a hospital\nExperience in hospital\n1. A postgraduate course or experience in any of the following services? (at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include tuberculosis)\nPsychiatric nursing\nOperating room\nAnaesthesia\nausucchisia ways drof mithod\nat mays clinic Rochester min\n2. Have you had any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\nM. D.\none academic year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\nIn what major field was above study?\n3. Training and experience in the public health field: Postgraduate 4 months or more\nCertificate\nDegree\nExperience 6 months\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\nHave you ever had any other air experience?\nYes\nNo\nSpecify\nI served over was in Frause in world Iat Base 82 (OVER)\nHave here doing prinate-duty since except for a 2 year Hept supt. Pacilitier.\nas also"
}