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Form 1045
Rev. Nov. 1942
AMERICAN RED CROSS
NURSING SERVICE
Indianspolic
If you have changed your last name since
contacting us, please check here
Name in full
TEAL.
Helen.
Tel. No. Market 5621
(last)
(first)
(middle)
If married, give maiden name
Date of birth 1889
Marital status
Husband's name
(single, married, widowed, divorced)
Permanent
address 734 (street) East mitchell Sr. Kendallinlle nober County- - Indiana
(city)
Probable address
(county)
(state)
for the next year 1125 (street) Circle Town Bldg (city) Indianapilis. (county) Marion county (state) - Indiana
Give name and address of nearest relative or friend in United States:
mn. g. D. Brinkenhoff (name) (relationship) Harrison (address) Sv. garrett Indiana
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)
Indiana State Nurses Association.
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) Executive secretary
If not employed, what type of nursing would you prefer to render?
How many years did you attend HIGH SCHOOL?
One
Two
Three
Four
Graduated
Yes
No
Before
entering
training,
how
many
years
did
you
attend
COLLEGE?
1yr.
Did
you
have
a
five-year
course
granting
bachelor's
degree?
AFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-
Postgraduate course
in a hospital
Experience in hospital
1. A postgraduate course or experience in any of the following services? (at least 3 months)
(at least 6 months)
Communicable disease nursing (include tuberculosis)
Psychiatric nursing
Operating room
Anaesthesia
2. Have you had any courses in a college or university?
Less than
One
Two
Three
Four
Bachelor's
Master's
Ph.D.
M. D.
one academic year
year
years
years
years
degree
degree
degree
degree
In
what
major
field
was
above
study?
Education
and
public
health
nursing
3. Training and experience the public health field: Postgraduate 4 months or more
Certificate
Degree
Experience 6 months
Have you ever held a position as an air hostess?
Yes
No
How long?
C
Have you ever had any other air experience?
Yes
No
Specify
(OVER)
Page data
- Page
- 22
- Source index
- 0
- Type
- photo
- Media ID
- 2fa2277b3bd7244e
- Size
- unknown
Document data
- ID
- 2662347
- Core
- doc
- Type
- document
DTO data
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Context sent to Scholar
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"ocrText": "Form 1045\nRev. Nov. 1942\nAMERICAN RED CROSS\nNURSING SERVICE\nIndianspolic\nIf you have changed your last name since\ncontacting us, please check here\nName in full\nTEAL.\nHelen.\nTel. No. Market 5621\n(last)\n(first)\n(middle)\nIf married, give maiden name\nDate of birth 1889\nMarital status\nHusband's name\n(single, married, widowed, divorced)\nPermanent\naddress 734 (street) East mitchell Sr. Kendallinlle nober County- - Indiana\n(city)\nProbable address\n(county)\n(state)\nfor the next year 1125 (street) Circle Town Bldg (city) Indianapilis. (county) Marion county (state) - Indiana\nGive name and address of nearest relative or friend in United States:\nmn. g. D. Brinkenhoff (name) (relationship) Harrison (address) Sv. garrett Indiana\nAre you employed in nursing at the present time?\nYes\nNo\nPRESENT EMPLOYMENT (check below) Name of agency or institution with which employed\nInstitutional\nPublic health\nIndustrial\nPrivate duty\nOther (write in)\nIndiana State Nurses Association.\nGovernment Service: Army, Regular\nNavy, Regular\nVeterans Administration\nReserve\nReserve\nChildren's Bureau\nU.S.P.H. Service\nU.S.\nIndian\nService\nMAJOR RESPONSIBILITIES\nAdministration\nTeaching\nPrivate duty\nof present employment\nSupervision\nGeneral staff\nOther (specify) Executive secretary\nIf not employed, what type of nursing would you prefer to render?\nHow many years did you attend HIGH SCHOOL?\nOne\nTwo\nThree\nFour\nGraduated\nYes\nNo\nBefore\nentering\ntraining,\nhow\nmany\nyears\ndid\nyou\nattend\nCOLLEGE?\n1yr.\nDid\nyou\nhave\na\nfive-year\ncourse\ngranting\nbachelor's\ndegree?\nAFTER GRADUATION FROM YOUR SCHOOL OF NURSING, did you have-\nPostgraduate course\nin a hospital\nExperience in hospital\n1. A postgraduate course or experience in any of the following services? (at least 3 months)\n(at least 6 months)\nCommunicable disease nursing (include tuberculosis)\nPsychiatric nursing\nOperating room\nAnaesthesia\n2. Have you had any courses in a college or university?\nLess than\nOne\nTwo\nThree\nFour\nBachelor's\nMaster's\nPh.D.\nM. D.\none academic year\nyear\nyears\nyears\nyears\ndegree\ndegree\ndegree\ndegree\nIn\nwhat\nmajor\nfield\nwas\nabove\nstudy?\nEducation\nand\npublic\nhealth\nnursing\n3. Training and experience the public health field: Postgraduate 4 months or more\nCertificate\nDegree\nExperience 6 months\nHave you ever held a position as an air hostess?\nYes\nNo\nHow long?\nC\nHave you ever had any other air experience?\nYes\nNo\nSpecify\n(OVER)"
}