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Form 1045
Rev. Nov. 1941
AMERICAN RED CROSS
NURSING SERVICE
Name in full Maustield (last) Bernice (first) Deane
Tel. No.
5428- Bangor
(middle)
If married, give maiden name
Year of birth
1879
B
Marital status
Husband's name
(single, married, widowed, divorced)
e
Permanent address 191 State
Banger
Penebscot
maine
(street)
(city)
(county)
(state)
Probable address
for the next year
Same
(street)
(city)
(county)
(state)
ce
Give name and address of nearest relative or friend in United States:
Dr. B. (name) m mansfield
Sister
191 state St. Bangor, maine
(relationship)
(address)
D
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
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
(at least 3 months)
yes
or public health field
(at least 6 months)
yes.
Communicable disease nursing (include Tbc)
/
Psychiatric Nursing
Operating room
Anaesthesia
Public health nursing
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
* one year
year
years
years
years
degree
degree
degree
Public Health
In what major field was above study?
What languages, other than English, do you speak?
none
* Academic year
(OVER)
Page data
- Page
- 13
- Source index
- 0
- Type
- photo
- Media ID
- 065e48e0df531d7b
- Size
- unknown
Document data
- ID
- 2661884
- Core
- doc
- Type
- document
DTO data
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"ocrText": "M\nForm 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\nNURSING SERVICE\nName in full Maustield (last) Bernice (first) Deane\nTel. No.\n5428- Bangor\n(middle)\nIf married, give maiden name\nYear of birth\n1879\nB\nMarital status\nHusband's name\n(single, married, widowed, divorced)\ne\nPermanent address 191 State\nBanger\nPenebscot\nmaine\n(street)\n(city)\n(county)\n(state)\nProbable address\nfor the next year\nSame\n(street)\n(city)\n(county)\n(state)\nce\nGive name and address of nearest relative or friend in United States:\nDr. B. (name) m mansfield\nSister\n191 state St. Bangor, maine\n(relationship)\n(address)\nD\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\nIndustrial\nPrivate duty\nOther (write in)\nGovernment Service: Army, Regular\nNavy, Regular\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? One\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\n(at least 3 months)\nyes\nor public health field\n(at least 6 months)\nyes.\nCommunicable disease nursing (include Tbc)\n/\nPsychiatric Nursing\nOperating room\nAnaesthesia\nPublic health nursing\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\n* one year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\nPublic Health\nIn what major field was above study?\nWhat languages, other than English, do you speak?\nnone\n* Academic year\n(OVER)"
}