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DEC 1 5 1943
FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
a
ANNUAL QUESTIONNAIRE-1944
4
If you have changed your last name
e
Red Cross
Badge number 36,801
since contacting us, please check here.
eimain
Name in full Waler margibulite
Tel. No. Temple1639
(last)
(first)
(middle)
If married, give maiden name
Date of birth
Marital status
-
Husband's name
(single, married, widowed, divorced)
Permanent address 104 Scotland Drd Southbrange Essey Co - NewJersey
(street)
(city)
(county)
(state)
Present address 820 Alex andria-
Viriginia
(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. Chave LD HenderSighth , 512iving stor Ave, NewBrunswice N.J. (relationship) sioter
(name)
(address)
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
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?
(specify date)
Not available, for the following reason ? Not under 45.
(specify)
Do you have any dependents under 14 years of age? Yes
No
W
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? yes
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 only as director at area headquavters-
Page data
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- Source index
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- Type
- photo
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Document data
- ID
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- Core
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- Type
- document
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"ocrText": "S.\n+\non\nDEC 1 5 1943\nFORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\na\nANNUAL QUESTIONNAIRE-1944\n4\nIf you have changed your last name\ne\nRed Cross\nBadge number 36,801\nsince contacting us, please check here.\neimain\nName in full Waler margibulite\nTel. No. Temple1639\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate of birth\nMarital status\n-\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 104 Scotland Drd Southbrange Essey Co - NewJersey\n(street)\n(city)\n(county)\n(state)\nPresent address 820 Alex andria-\nViriginia\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. Chave LD HenderSighth , 512iving stor Ave, NewBrunswice N.J. (relationship) sioter\n(name)\n(address)\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\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?\n(specify date)\nNot available, for the following reason ? Not under 45.\n(specify)\nDo you have any dependents under 14 years of age? Yes\nNo\nW\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? yes\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 only as director at area headquavters-"
}