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I
C
FORM 1045
BEV. JAN 1941
2
AMERICAN RED CROSS
(b
NATIONAL HEADQUARTERS
1
WASHINGTON, D. C.
d
Name in full
Hickcox.
Verda
Fern
Year of Birth Dec. 1891
a
(SURNAME)
(FIRST)
(MIDDLE)
Husband's name
F
1320 York Ave.
New York
New York
"ew York
Permanent address
(STREET)
(CITY)
(COUNTY)
(STATE)
Probable address
for the next year same as above
(STREET)
(CITY)
(COUNTY)
(STATE)
Telephone number
Regent 4 6000, Ext. 7030
(EXCHANGE)
(NO.)
Give name and address of nearest relative or friend in United States:
Mrs Jule Klosterman
sister
40 Maplewood Ave., Bogota, New Jersey
(NAME)
(RELATIONSHIP)
(ADDRESS)
PRESENT EMPLOYMENT (check below)
Name of agency or institution with which employed
Institutional
V
Womans Clinic, New York Hospital, New York City, N.Y.
Public Health
Private duty
Other (write in)
Government Service: Army
U.S.P.H. Service
Veterans Administration
Navy
U.S.Indian Service
Children's Bureau
MAJOR ESPONSIBILITIES Adminis-
Super
Teach-
General
Private
Other
of present employment tration
V
vision
ing
Staff
Duty
(specify)
IF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:
Institutional
Public Health
Private duty
Other
(WRITE IN)
AVAILABILITY
Not unless there seemed some special reason why
At the present time would you
I should do
Date
accept assignment to the Army? Yes
No
Navy? Yes
No
available
In case of a war emergency would you
a. Am past the age
accept assignment to the Army? Yes
No
Navy? Yes
No
limit so would probab
ly not be called.
b. If it were determined that I would be more use there than here I would go.
If not now employed would you
accept nursing work? Full-time? Yes
No
Part-time? Yes
No
In your own community? Yes
No
Elsewhere? Yes
No
Would you be interested in teaching classes in Home Hygiene and Care of the Sick? No
Present physical condition Fairly goad, Run persistantly low basal metabolism.
Badge No. 15445
Current date Feb. 14 1941
Name of Committee MANHATTAN
C
Note: If a nurse does not complete and return this questionnaire, and cannot be located
within two years, her enrollment will be removed from our active files.
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- Source index
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- Type
- photo
- Media ID
- b4708ba93315c6ed
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- unknown
Document data
- ID
- 2661638
- Core
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- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "I\nC\nFORM 1045\nBEV. JAN 1941\n2\nAMERICAN RED CROSS\n(b\nNATIONAL HEADQUARTERS\n1\nWASHINGTON, D. C.\nd\nName in full\nHickcox.\nVerda\nFern\nYear of Birth Dec. 1891\na\n(SURNAME)\n(FIRST)\n(MIDDLE)\nHusband's name\nF\n1320 York Ave.\nNew York\nNew York\n\"ew York\nPermanent address\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nProbable address\nfor the next year same as above\n(STREET)\n(CITY)\n(COUNTY)\n(STATE)\nTelephone number\nRegent 4 6000, Ext. 7030\n(EXCHANGE)\n(NO.)\nGive name and address of nearest relative or friend in United States:\nMrs Jule Klosterman\nsister\n40 Maplewood Ave., Bogota, New Jersey\n(NAME)\n(RELATIONSHIP)\n(ADDRESS)\nPRESENT EMPLOYMENT (check below)\nName of agency or institution with which employed\nInstitutional\nV\nWomans Clinic, New York Hospital, New York City, N.Y.\nPublic Health\nPrivate duty\nOther (write in)\nGovernment Service: Army\nU.S.P.H. Service\nVeterans Administration\nNavy\nU.S.Indian Service\nChildren's Bureau\nMAJOR ESPONSIBILITIES Adminis-\nSuper\nTeach-\nGeneral\nPrivate\nOther\nof present employment tration\nV\nvision\ning\nStaff\nDuty\n(specify)\nIF NOT EMPLOYED IN NURSING check field of nursing with which you are most familiar:\nInstitutional\nPublic Health\nPrivate duty\nOther\n(WRITE IN)\nAVAILABILITY\nNot unless there seemed some special reason why\nAt the present time would you\nI should do\nDate\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\navailable\nIn case of a war emergency would you\na. Am past the age\naccept assignment to the Army? Yes\nNo\nNavy? Yes\nNo\nlimit so would probab\nly not be called.\nb. If it were determined that I would be more use there than here I would go.\nIf not now employed would you\naccept nursing work? Full-time? Yes\nNo\nPart-time? Yes\nNo\nIn your own community? Yes\nNo\nElsewhere? Yes\nNo\nWould you be interested in teaching classes in Home Hygiene and Care of the Sick? No\nPresent physical condition Fairly goad, Run persistantly low basal metabolism.\nBadge No. 15445\nCurrent date Feb. 14 1941\nName of Committee MANHATTAN\nC\nNote: If a nurse does not complete and return this questionnaire, and cannot be located\nwithin two years, her enrollment will be removed from our active files."
}