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HAWAIIAN UNIT -- RETURN TO MRS. E. AMICK
Confidential
Please return
AMERICAN RED CROSS Exiend
FORM 1219
REV. JUNE 1942
APPLICATION FOR EMPLOYMENT - NURSING PERSONNEL
I. PERSONAL
Badge (No 63458
Name in full Miss Reba Kalhryn Beale
(H.D.
(MISS OR MRS.)
(IF MARRIED, GIVE MAIDEN NAME ALSO)
Not enrolled
a
Present address. 3702 1.Illinois Indianapolis, Indiana Tel. No Talbot 7172
(STREET)
(CITY)
(STATE)
+
Permanent address same
Tel. No
5
(STREET)
(CITY)
(STATE)
Citizenship us.
Color While
Place of birth North Baltimore Ohio
T
+
Present position
Date of birth 1902
(TITLE)
(SALARY)
5
Indianapolis Public Health nursingAssin Indianapolis, Ind
Single
Widowed
(ORGANIZATION)
(ADDRESS)
Married
Divorced
II. PROFESSIONAL STATUS
States registered Indiana
Current registration Indiana
To what professional organizations do you belong? A.N.A. n.a.P.H.N.
If not an enrolled Red Cross nurse, has your application for enrollment been submitted to
your Local Committee Red Cross Nursing Service? (NOT chapter committee)
When and to whom?
III. EDUCATION
1. Prior to entering school of nursing:
Name
City and State
Dates Diploma-Degree
Major
High School RushviLLe
Rushville Ind
English
Normal School Indiana
Terre Haule Ind
1921-1922
Commercial
University Indianaleniverily
Bloemington
1941-1942
nursinged
Other Indiana.university Extension Indianaposis Ind
"
"
2. School of nursing from) Indiana Universily School of nursing- - Indianapolis Ind.
which you graduated)
(NAME)
(CITY)
(STATE)
Length of course
5 years
3 years
(Specify other)
Date completed 1333
3. Undergraduate affiliations:
Hospital or Organization
City and State
Clinical Specialty No. Months
(1)
(2)
(3)
4. Postgraduate clinical courses: (Do not include academic work or employment.)
W
Hospital or Organization
City and State
Clinical Specialty
Dates
(1)
(2)
r
(3)
or
5. Academic study since graduation from school of nursing:
June
5
College or University
City and State
Academic years
No. Points
(1)Indiana University
Bhromington, Ind
isemester
15hr
Indianapolis. ,Ind
17hr,
(3)
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"ocrText": "HAWAIIAN UNIT -- RETURN TO MRS. E. AMICK\nConfidential\nPlease return\nAMERICAN RED CROSS Exiend\nFORM 1219\nREV. JUNE 1942\nAPPLICATION FOR EMPLOYMENT - NURSING PERSONNEL\nI. PERSONAL\nBadge (No 63458\nName in full Miss Reba Kalhryn Beale\n(H.D.\n(MISS OR MRS.)\n(IF MARRIED, GIVE MAIDEN NAME ALSO)\nNot enrolled\na\nPresent address. 3702 1.Illinois Indianapolis, Indiana Tel. No Talbot 7172\n(STREET)\n(CITY)\n(STATE)\n+\nPermanent address same\nTel. No\n5\n(STREET)\n(CITY)\n(STATE)\nCitizenship us.\nColor While\nPlace of birth North Baltimore Ohio\nT\n+\nPresent position\nDate of birth 1902\n(TITLE)\n(SALARY)\n5\nIndianapolis Public Health nursingAssin Indianapolis, Ind\nSingle\nWidowed\n(ORGANIZATION)\n(ADDRESS)\nMarried\nDivorced\nII. PROFESSIONAL STATUS\nStates registered Indiana\nCurrent registration Indiana\nTo what professional organizations do you belong? A.N.A. n.a.P.H.N.\nIf not an enrolled Red Cross nurse, has your application for enrollment been submitted to\nyour Local Committee Red Cross Nursing Service? (NOT chapter committee)\nWhen and to whom?\nIII. EDUCATION\n1. Prior to entering school of nursing:\nName\nCity and State\nDates Diploma-Degree\nMajor\nHigh School RushviLLe\nRushville Ind\nEnglish\nNormal School Indiana\nTerre Haule Ind\n1921-1922\nCommercial\nUniversity Indianaleniverily\nBloemington\n1941-1942\nnursinged\nOther Indiana.university Extension Indianaposis Ind\n\"\n\"\n2. School of nursing from) Indiana Universily School of nursing- - Indianapolis Ind.\nwhich you graduated)\n(NAME)\n(CITY)\n(STATE)\nLength of course\n5 years\n3 years\n(Specify other)\nDate completed 1333\n3. Undergraduate affiliations:\nHospital or Organization\nCity and State\nClinical Specialty No. Months\n(1)\n(2)\n(3)\n4. Postgraduate clinical courses: (Do not include academic work or employment.)\nW\nHospital or Organization\nCity and State\nClinical Specialty\nDates\n(1)\n(2)\nr\n(3)\nor\n5. Academic study since graduation from school of nursing:\nJune\n5\nCollege or University\nCity and State\nAcademic years\nNo. Points\n(1)Indiana University\nBhromington, Ind\nisemester\n15hr\nIndianapolis. ,Ind\n17hr,\n(3)"
}