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a AUG 301944 199554 5 AMERICAN RED CROSS Form 1045. c Rev. July 1944 NURSING SERVICE ANNUAL QUESTIONNAIRE FOR NURSES ON FOREIGN DUTY-1944 If you have changed your last name I Red Cross badge No. 15362 since contacting us, please check here. Name in full BUNTING HildA Cutts Tel. No. for 9023 - D (last) (first) (middle) If married, give maiden name Hilda buth Date of birth 1882 a Marital status married Husband's (single, married, widowed, divorced) name Frederic H. Bunting C. Permanent address 2001 Bloor st. W. Toronto, Ontario, Canada Present address 2001 Bloor st. W. Taronts, Ontaris Canada C Notify national headquarters immediately if you change your address. Give name and address of nearest relative or friend in the United States: 3 Jean m. (name) butts 65 Eugene ane (address) Buffalo n.y nice (relationship) S, 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 posi- tion and the name and address of the employing agency or institution: Institutional Public Health Industrial Private Duty Other What language other than English do you speak? 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 nursing course granting a bachelor's degree? Yes No AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you. have: 1. A postgraduate course (at least 3 months in a hospital) or experience (at least 6 months in a hospital) in any of the following services? Course Number of months Experience Number of months Communicable disease nursing (includes tuberculosis) Psychiatric nursing Operating room Andesthesia 2. Any courses in a college or university? (Check in box.) Less than one one Two Three Four Bachelor's Master's Ph.D. M. D. academic year year years years years degree degree degree degree 5 In what major field was the above study? w 3. Experience or training in the public health field? Experience, 6 months or more 6 Postgraduate course, 4 months or more What is your present physical condition? serious Certificate Heart condition Degree 2 steda b. (Signature) Bunting Sept 8th 1944 (date this form is filled in) FILL IN AND RETURN TO NURSING SERVICE, RED CROSS NATIONAL HEADQUARTERS, WASHINGTON 13, D. C.

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    "ocrText": "a\nAUG 301944 199554\n5\nAMERICAN RED CROSS\nForm 1045. c\nRev. July 1944\nNURSING SERVICE\nANNUAL QUESTIONNAIRE FOR NURSES ON FOREIGN DUTY-1944\nIf you have changed your last name\nI\nRed Cross badge No. 15362\nsince contacting us, please check here.\nName in full BUNTING HildA\nCutts\nTel. No. for 9023\n-\nD\n(last)\n(first)\n(middle)\nIf married, give maiden name Hilda buth\nDate of birth 1882\na\nMarital status\nmarried\nHusband's\n(single, married, widowed, divorced)\nname Frederic H. Bunting\nC.\nPermanent address 2001 Bloor st. W. Toronto, Ontario, Canada\nPresent address 2001 Bloor st. W. Taronts, Ontaris Canada\nC\nNotify national headquarters immediately if you change your address.\nGive name and address of nearest relative or friend in the United States:\n3\nJean m. (name) butts 65 Eugene ane (address) Buffalo n.y nice (relationship)\nS,\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 posi-\ntion and the name and address of the employing agency or institution:\nInstitutional\nPublic Health\nIndustrial\nPrivate Duty\nOther\nWhat language other than English do you speak?\nHow many years did you attend high school? One\nTwo\nThree\nFour\nGraduated\nYes\nNo\nBEFORE entering training, how many years did you attend college?\nDid you have a five-year nursing course granting a bachelor's degree? Yes\nNo\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you. have:\n1. A postgraduate course (at least 3 months in a hospital) or experience (at least 6\nmonths in a hospital) in any of the following services?\nCourse\nNumber of months Experience Number of months\nCommunicable disease nursing\n(includes tuberculosis)\nPsychiatric nursing\nOperating room\nAndesthesia\n2. Any courses in a college or university? (Check in box.)\nLess than one\none\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\nM. D.\nacademic year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\n5\nIn what major field was the above study?\nw\n3. Experience or training in the public health field? Experience, 6 months or more\n6\nPostgraduate course, 4 months or more\nWhat is your present physical condition?\nserious Certificate Heart condition Degree\n2\nsteda b. (Signature) Bunting\nSept 8th 1944\n(date this form is filled in)\nFILL IN AND RETURN TO NURSING SERVICE, RED CROSS NATIONAL HEADQUARTERS, WASHINGTON 13, D. C."
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