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Hawaii Unit return to Mrs. Amick
Confidential
Please return
AMERICAN RED CROSS
Af
FORM 1219
REV,JUNE 1942
For
APPLICATION FOR EMPLOYMENT - NURSING PERSONNEL
I. PERSONAL
Name in full Miss Marion agnes (IF me namara Rn.
Badge (No. 77,850
(H.D.
(MISS OR MRS.)
MARRIED GIVE MAIDEN NAME ALSO)
Not enrolled
Present
address (STREET) (CITY) Tel. No
.403-3-2289
Permanent
address same
Tel. No. same
(STREET)
(CITY)
(STATE)
Citizenship Birth
Color while Place of birth Union City D.J.
Present position Industrial nurse
Date of birth Ocr 2, 911
(TITLE)
(SALARY)
Krafin Cheese (ORGANIZATION) Ce - Birgersy are (ADDRESS) JerocyCity of Single Married
Widowed
Divorced
II. PROFESSIONAL STATUS
States registered New Jersey
Current registration
6040
To what professional organizations do you belong? STATe nurses ass. American
nurses ass. Alum
If not an enrolled Red Cross nurse, has your application for enrollment been submitted to
your Local Committee Red Cross Nursing Service? (NOT chapter committee)
When and to whom?
III. EDUCATION
1. Prior to entering school of nursing:
Name
City and State Dates Diploma-Degree
Major
High School Emerson
Union
Normal School
University
Other
2. School of nursing from) Jerocy CityMedical (NAME) Center (CITY) JerocyCiting newfersey (STA/TE)
which you graduated)
Length of course
5 years
3 years
(Specify other)
Date completed 1930
3. Undergraduate affiliations:
Hospital or Organization
City and State
Clinical Specialty No. Months
(1)
(2)
(3)
4. Postgraduate clinical courses: (Do not include academic work or employment.)
(1) Publicisialin (ourse
Hospital or Organization
City and State
Clinical Specialty
Dates
(2) Obstotricial Dursing. - newyork; lying In obstetrics
ModicAllents JG Public HeAlth
1931
1931
(3)
Hosp Ded york
5. Academic study since graduation from school of nursing:
College or University
City and State
Academic years
No. Points
(1)
(2)
(3)
Page data
- Page
- 77
- Source index
- 0
- Type
- photo
- Media ID
- 61908a1193d4dce7
- Size
- unknown
Document data
- ID
- 2661949
- Core
- doc
- Type
- document
DTO data
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Document source extras
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"ocrText": "Hawaii Unit return to Mrs. Amick\nConfidential\nPlease return\nAMERICAN RED CROSS\nAf\nFORM 1219\nREV,JUNE 1942\nFor\nAPPLICATION FOR EMPLOYMENT - NURSING PERSONNEL\nI. PERSONAL\nName in full Miss Marion agnes (IF me namara Rn.\nBadge (No. 77,850\n(H.D.\n(MISS OR MRS.)\nMARRIED GIVE MAIDEN NAME ALSO)\nNot enrolled\nPresent\naddress (STREET) (CITY) Tel. No\n.403-3-2289\nPermanent\naddress same\nTel. No. same\n(STREET)\n(CITY)\n(STATE)\nCitizenship Birth\nColor while Place of birth Union City D.J.\nPresent position Industrial nurse\nDate of birth Ocr 2, 911\n(TITLE)\n(SALARY)\nKrafin Cheese (ORGANIZATION) Ce - Birgersy are (ADDRESS) JerocyCity of Single Married\nWidowed\nDivorced\nII. PROFESSIONAL STATUS\nStates registered New Jersey\nCurrent registration\n6040\nTo what professional organizations do you belong? STATe nurses ass. American\nnurses ass. Alum\nIf not an enrolled Red Cross nurse, has your application for enrollment been submitted to\nyour Local Committee Red Cross Nursing Service? (NOT chapter committee)\nWhen and to whom?\nIII. EDUCATION\n1. Prior to entering school of nursing:\nName\nCity and State Dates Diploma-Degree\nMajor\nHigh School Emerson\nUnion\nNormal School\nUniversity\nOther\n2. School of nursing from) Jerocy CityMedical (NAME) Center (CITY) JerocyCiting newfersey (STA/TE)\nwhich you graduated)\nLength of course\n5 years\n3 years\n(Specify other)\nDate completed 1930\n3. Undergraduate affiliations:\nHospital or Organization\nCity and State\nClinical Specialty No. Months\n(1)\n(2)\n(3)\n4. Postgraduate clinical courses: (Do not include academic work or employment.)\n(1) Publicisialin (ourse\nHospital or Organization\nCity and State\nClinical Specialty\nDates\n(2) Obstotricial Dursing. - newyork; lying In obstetrics\nModicAllents JG Public HeAlth\n1931\n1931\n(3)\nHosp Ded york\n5. Academic study since graduation from school of nursing:\nCollege or University\nCity and State\nAcademic years\nNo. Points\n(1)\n(2)\n(3)"
}