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FORM 1045
REV. OCT. 1943
AMERICAN RED CROSS
NURSING SERVICE
ANNUAL QUESTIONNAIRE-1944
Red Cross
Badge number 4055
If you have changed your last name
since contacting us, please check here.
Name in full Van Zile Mary
-
Tel. No. Casa grade
(last)
(first)
(middle)
If married, give maiden name
Date of birth Chc 3, 1874
103
Marital status
Husband's name
Permanent address OBBx 623 Casagrande Pinal
(single, married, widowed, divorced)
Arizona
(street)
(city)
(county)
(state)
Present address Same
(street)
(city)
(county)
(state)
Notify national headquarters immediately if you change your address.
friend Mrs - N. Bess Prather, Postmaster, Casa hende , Anzina Friend
Give name and address of nearest relative or friend in the United States:
(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:
Institutional
Public Health
Industrial
Private Duty
Other
Un leld Age Assistance
If not employed, what type nursing you
of would prefer to render? Public Health
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?
Noteligible at
(specify date)
Not available, for the following reason?
(specify)
Age 69 -
Do you have any dependents under 14 years of age? Yes
No
AVAILABILITY FOR SERVICE WITH CIVILIANS
2/22/44
e
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?
yes.
3rll
To take a Red Cross emergency assignment?
yes
To serve overseas caring for civilians?
? At age 69
Have you ever served with the Red Cross in a disaster? Yes
No
would be glad serve
If yes, specify to type of disaster Influenge Epidemic 1918m Mess 1919 h
in any way compatitive with your regulations
1920 Mame
Page data
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Document data
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- Core
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- Type
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Context sent to Scholar
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"ocrText": "FORM 1045\nREV. OCT. 1943\nAMERICAN RED CROSS\nNURSING SERVICE\nANNUAL QUESTIONNAIRE-1944\nRed Cross\nBadge number 4055\nIf you have changed your last name\nsince contacting us, please check here.\nName in full Van Zile Mary\n-\nTel. No. Casa grade\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate of birth Chc 3, 1874\n103\nMarital status\nHusband's name\nPermanent address OBBx 623 Casagrande Pinal\n(single, married, widowed, divorced)\nArizona\n(street)\n(city)\n(county)\n(state)\nPresent address Same\n(street)\n(city)\n(county)\n(state)\nNotify national headquarters immediately if you change your address.\nfriend Mrs - N. Bess Prather, Postmaster, Casa hende , Anzina Friend\nGive name and address of nearest relative or friend in the United States:\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:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nUn leld Age Assistance\nIf not employed, what type nursing you\nof would prefer to render? Public Health\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?\nNoteligible at\n(specify date)\nNot available, for the following reason?\n(specify)\nAge 69 -\nDo you have any dependents under 14 years of age? Yes\nNo\nAVAILABILITY FOR SERVICE WITH CIVILIANS\n2/22/44\ne\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?\nyes.\n3rll\nTo take a Red Cross emergency assignment?\nyes\nTo serve overseas caring for civilians?\n? At age 69\nHave you ever served with the Red Cross in a disaster? Yes\nNo\nwould be glad serve\nIf yes, specify to type of disaster Influenge Epidemic 1918m Mess 1919 h\nin any way compatitive with your regulations\n1920 Mame"
}