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Clay, Josephine A.

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311 2nd RED CROSS BADGE NUMBER AMERICAN RED CROSS 5408 NURSING SERVICES MILITARY SERIAL NUMBER ANNUAL QUESTIONNAIRE - 1945 CHECK IF YOUR LAST NAME HAS CHANGED S NAME (Last, first, middle) TELEPHONE NO. IF MARRIED, GIVE MAIDEN NAME Clay HUSBAND'S NAME 9 . Josephine Ten 5690 6 PERMANENT ADDRESS (Street, city, zone, county, state) PRESENT ADDRESS (Street, city, zone, county, state) He denoy 13rspruce sto Philadelphia) same RELATIONSHIP e NAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES Cuslend Claylon archst. Pheladelphia Brother DATE OF BIRTH (Month, day, ylear) W1 dowed Divorced may 18th 1878 Single Married Separated YES NO D WHAT LANGUAGES DO YOU SPEAK? English strench HIGH SCHOOL GRADUATE NAME OF COLLEGE OR DEGREE OR UNIVERSITY ATTENDED LOCATION INCLUSIVE DATES DIPLOMA MAJOR ARE YOU CURRENTLY YES REGISTERED IN (State) ARE YOU CURRENTLY A MEMBER OF THE AMERICAN YES NO NO REGISTERED? V Terma NURSES' ASSOCIATION? PRESENT EMPLOYMENT If not employed, check POSITION TITLE (H.N., P.D., inst., staff nurse, etc.) SERVICE (Medicine, surgery, etc.) NAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED CITY STATE HEALTH IF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY VOLUNTEER SERVICE The purpose of the following statements is to identify the nurses who can be counted upon to respond to a call to participate in a Red Cross chapter program. Please check the "Yes" box only if you are villing and able to serve if called on wi ithin the next 12 months. NAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT. 12 MONTHS South Easlern Tennsylvance Chaphes 1. Teach home YES NO Attend an instructors' training program, if offered. (Funds are available for YES NO nursing classes training home nursing instructors. See local chapter.) 2. Serve in case YES only in home community Attend disaster institutes, if YES NO NO of disaster In other communities offered, in preparation for service 4. Accept membership on chapter com- YES NO 5. Assist with other chapter YES NO 3. Teach nurse's YES NO aide classes mittee should services be needed programs, as needed If you have not answered "Yes" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that YES NO you will be able to serve at some time in the future? In Case IF UNABLE TO SERVE, GIVE MAJOR REASONS. DATE S IGNATURE belober 8th 1945 YOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHFULKESS Josephine a. Clay ,IN KEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONWAIRE AND RETURN IT PROMPTLY TO THE COMMITTEE NAMED BELOW. a ATTENTION Fill in committee name and address before sending questionnaire to nurse. Nurse Recruiting Committee SECRETARY 511 North Broad Street NURSE RECRUITMENT Philadelphia, Pa. 1/1/46 COMMITTEE FORM 1045 Rev. July 1945 78504M

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Page
8
Source index
0
Type
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Media ID
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Size
unknown

Document data

ID
2661250
Core
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Type
document
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Context sent to Scholar

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    "ocrText": "311\n2nd\nRED CROSS BADGE NUMBER\nAMERICAN RED CROSS\n5408\nNURSING SERVICES\nMILITARY SERIAL NUMBER\nANNUAL QUESTIONNAIRE - 1945\nCHECK IF YOUR LAST NAME HAS CHANGED\nS\nNAME (Last, first, middle)\nTELEPHONE NO.\nIF MARRIED, GIVE MAIDEN\nNAME Clay HUSBAND'S NAME 9 .\nJosephine\nTen 5690\n6\nPERMANENT ADDRESS (Street, city, zone, county, state)\nPRESENT\nADDRESS\n(Street,\ncity,\nzone,\ncounty, state) He denoy 13rspruce sto Philadelphia)\nsame\nRELATIONSHIP\ne\nNAME AND ADDRESS OF NEAREST RELATIVE OR FRIEND IN THE UNITED STATES\nCuslend Claylon archst. Pheladelphia\nBrother\nDATE OF BIRTH (Month, day, ylear)\nW1 dowed\nDivorced\nmay 18th 1878\nSingle\nMarried\nSeparated\nYES\nNO\nD\nWHAT LANGUAGES DO YOU SPEAK?\nEnglish strench\nHIGH SCHOOL GRADUATE\nNAME OF COLLEGE OR\nDEGREE OR\nUNIVERSITY ATTENDED\nLOCATION\nINCLUSIVE DATES\nDIPLOMA\nMAJOR\nARE YOU CURRENTLY\nYES\nREGISTERED IN (State)\nARE YOU CURRENTLY A MEMBER OF THE AMERICAN\nYES\nNO\nNO\nREGISTERED?\nV\nTerma\nNURSES' ASSOCIATION?\nPRESENT EMPLOYMENT If not employed, check\nPOSITION TITLE (H.N., P.D., inst., staff nurse, etc.)\nSERVICE (Medicine, surgery, etc.)\nNAME OF HOSPITAL OR ORGANIZATION BY WHOM EMPLOYED\nCITY\nSTATE\nHEALTH\nIF OTHER THAN GOOD, SPECIFY NATURE AND ANTICIPATED DURATION OF DISABILITY\nVOLUNTEER SERVICE\nThe purpose of the following statements is to identify the nurses who can be counted upon to respond to a call\nto participate in a Red Cross chapter program. Please check the \"Yes\" box only if you are villing and able to\nserve if called on wi ithin the next 12 months.\nNAME AND ADDRESS OF THE CHAPTER IN WHOSE JURISDICTION YOU EXPECT TO LIVE FOR THE NEXT. 12 MONTHS\nSouth Easlern Tennsylvance Chaphes\n1. Teach home\nYES\nNO\nAttend an instructors' training program, if offered. (Funds are available for\nYES\nNO\nnursing classes\ntraining home nursing instructors. See local chapter.)\n2. Serve in case\nYES\nonly in home community\nAttend disaster institutes, if\nYES\nNO\nNO\nof disaster\nIn other communities\noffered, in preparation for service\n4. Accept membership on chapter com-\nYES\nNO\n5. Assist with other chapter\nYES\nNO\n3. Teach nurse's\nYES\nNO\naide classes\nmittee should services be needed\nprograms, as needed\nIf you have not answered \"Yes\" to any of the questions listed under VOLUNTEER SERVICE, do you anticipate that\nYES\nNO\nyou\nwill be able to serve at some time in the future? In Case\nIF UNABLE TO SERVE, GIVE MAJOR REASONS.\nDATE\nS IGNATURE\nbelober 8th 1945\nYOUR VALUE AS A RED CROSS NURSE DEPENDS ON YOUR ABILITY AND WILLINGNESS TO SERVE AND YOUR PAITHFULKESS\nJosephine a. Clay\n,IN\nKEEPING US INFORMED OF YOUR ADDRESS. PLEASE FILL IN THIS QUESTIONWAIRE AND RETURN IT PROMPTLY TO\nTHE\nCOMMITTEE NAMED BELOW.\na\nATTENTION\nFill in committee name and address before sending questionnaire to nurse.\nNurse Recruiting Committee\nSECRETARY\n511 North Broad Street\nNURSE RECRUITMENT\nPhiladelphia, Pa.\n1/1/46\nCOMMITTEE\nFORM 1045 Rev. July 1945\n78504M"
}