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Form 1045
Rust
Rev. Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
M
Name in full
HARRIS, Mary Alice
Tel. No.
(last)
(first)
(middle)
a
If married, give maiden name
Year of birth 9-28-10
Marital status
Single
Husband's name
(single, married, widowed, divorced)
A
Permanent address 1400 West Main -Dothan, Houston
Alabama
(street)
(city)
(county)
(state)
-
Probable address
Box 23
Monroe,
Union
for the next year
North Carolina
(street)
(city)
(county)
(state)
c
Give name and address of nearest relative or friend in United States:
e
Lisenby, Mrs. Irene Davis -Friend
1400 West Main St., Dothan, Alahama
(name)
(relationship)
(address)
Are you employed in nursing at the present time? Yes
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
Institutional
Public health
U.S.P.H. Service -started Septemher 23rd, 1941
Industrial
Private duty
Other (write in)
Government Service: Army, Regular
Navy,
Regular
Veterans Administration
Reserve
Reserve
Children's Bureau
U.S.P.H. Service
U.S. Indian Service
MAJOR RESPONSIBILITIES
Administration
Teaching
Private duty
of present employment
Supervision
General Staff
Other (specify)
How many years did you attend HIGH SCHOOL?
One
Two
Three
Four
Graduated
Yes
No
SINCE GRADUATION FROM YOUR SCHOOL OF NURSING
have you ever had-
1. A postgraduate course or experience in any of the following special services?
Postgraduate course
Experience in hospital
in a hospital
or public health field
(at least 3 months)
(at least 6 months)
Communicable disease nursing (include Tbc)
Psychiatric Nursing
Operating room
Anaesthesia
Public health nursing
have public health - dertificate
Lying-in Hospital, Chicago 4 mo. getting certificate
6
2. Have you taken any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
P.H.D.
Certificate in
2
one year
year
years
years
years
degree
degree
degree
Public Health
E
In what major field was above study? Public Health and Social science
What languages, other than English, do you speak? None
* Academic year
(OVER)
Page data
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- Source index
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- Type
- photo
- Media ID
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- Size
- unknown
Document data
- ID
- 2661593
- Core
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- Type
- document
DTO data
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Document source extras
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"ocrText": "I\narr\na\nForm 1045\nRust\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nM\nName in full\nHARRIS, Mary Alice\nTel. No.\n(last)\n(first)\n(middle)\na\nIf married, give maiden name\nYear of birth 9-28-10\nMarital status\nSingle\nHusband's name\n(single, married, widowed, divorced)\nA\nPermanent address 1400 West Main -Dothan, Houston\nAlabama\n(street)\n(city)\n(county)\n(state)\n-\nProbable address\nBox 23\nMonroe,\nUnion\nfor the next year\nNorth Carolina\n(street)\n(city)\n(county)\n(state)\nc\nGive name and address of nearest relative or friend in United States:\ne\nLisenby, Mrs. Irene Davis -Friend\n1400 West Main St., Dothan, Alahama\n(name)\n(relationship)\n(address)\nAre you employed in nursing at the present time? Yes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nU.S.P.H. Service -started Septemher 23rd, 1941\nIndustrial\nPrivate duty\nOther (write in)\nGovernment Service: Army, Regular\nNavy,\nRegular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S. Indian Service\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral Staff\nOther (specify)\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nSINCE GRADUATION FROM YOUR SCHOOL OF NURSING\nhave you ever had-\n1. A postgraduate course or experience in any of the following special services?\nPostgraduate course\nExperience in hospital\nin a hospital\nor public health field\n(at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include Tbc)\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing\nhave public health - dertificate\nLying-in Hospital, Chicago 4 mo. getting certificate\n6\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nP.H.D.\nCertificate in\n2\none year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nE\nIn what major field was above study? Public Health and Social science\nWhat languages, other than English, do you speak? None\n* Academic year\n(OVER)"
}