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Form 1045
Rev. Nov. 1941
AMERICAN RED CROSS
102
NURSING SERVICE
102
Name in full
Storey
Marjory
Tel. No
(last)
(first)
(middle)
If married, give maiden name
Year of birth
1898
Marital status
Single
Husband's name
(single, married, widowed, divorced)
Permanent address 30Hortenss St.
Rochester
Monroe
n.4.
(street)
Probable address
(city)
(county)
(state)
for the next year
411 W. 116th st.
newYorkCity
3months
(street)
(city)
n.4.
(county)
(state)
Give name and address of nearest relative or friend in United States:
mrs. games spining
Sister
(name)
568 Wellington aw Rochester, n.y.
(relationship)
(address)
Are you employed in nursing at the present time? Yes
qen.2216g
No
PRESENT EMPLOYMENT (check below) Name of agency or institution with which employed
Institutional
Public health
Visiting nursi Assn Rochestri, n.4.
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
of present employment
Private duty
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
2. Have you taken any courses in a college or university?
Less than
One
Two
Three
Four
one year
Bachelor's
Master's
year
years
P.H.D.
years
years
Certificate in
degree
degree
degree
Public Health
In what major field was above study? History x Economics
What languages, other than English, do you speak?
-
*Academic year
(OVER)
Page data
- Page
- 34
- Source index
- 0
- Type
- photo
- Media ID
- 30adc1dd88a25f8a
- Size
- unknown
Document data
- ID
- 2662321
- Core
- doc
- Type
- document
DTO data
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"ocrText": "1\nForm 1045\nRev. Nov. 1941\nAMERICAN RED CROSS\n102\nNURSING SERVICE\n102\nName in full\nStorey\nMarjory\nTel. No\n(last)\n(first)\n(middle)\nIf married, give maiden name\nYear of birth\n1898\nMarital status\nSingle\nHusband's name\n(single, married, widowed, divorced)\nPermanent address 30Hortenss St.\nRochester\nMonroe\nn.4.\n(street)\nProbable address\n(city)\n(county)\n(state)\nfor the next year\n411 W. 116th st.\nnewYorkCity\n3months\n(street)\n(city)\nn.4.\n(county)\n(state)\nGive name and address of nearest relative or friend in United States:\nmrs. games spining\nSister\n(name)\n568 Wellington aw Rochester, n.y.\n(relationship)\n(address)\nAre you employed in nursing at the present time? Yes\nqen.2216g\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nVisiting nursi Assn Rochestri, n.4.\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\nof present employment\nPrivate duty\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\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\n2. Have you taken any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\none year\nBachelor's\nMaster's\nyear\nyears\nP.H.D.\nyears\nyears\nCertificate in\ndegree\ndegree\ndegree\nPublic Health\nIn what major field was above study? History x Economics\nWhat languages, other than English, do you speak?\n-\n*Academic year\n(OVER)"
}