Population Census Aide à la compréhension Individual form

Exemple : DUPAS, épouse MAURIN

Surname : ______To be completed by enumerator

Given name (first name) : ______

Address : ______municipality

______departement

1 7 Sex Male 1 Female 2 The remainder of the questionnaire concerns people aged 14 and over. 2 Date and place of birth 8 Are you living in a union ? Yes 1 No 2 Born : 9 day month year Are you… ? Married…………… 1 In a civil union (PACS)………….. 2 in : In a non-marital or common-law union………………..….…. 3 municipality (and arrondissement for Paris, , ) Widowed…………. 4 Divorced………….……………….. 5 Single…………………………………………………..……. 6

Département number n° DOM (if born abroad) Métropolitan France (for French overseas TOMs) 10 What qualifications do you have ?

3 If you were born abroad, in what year did you arrive in You did not go to school or left before the end of France ? primary school ……………………………………………..….…. 1 You have no qualifications and left education at the end of year primary school or before the end of middle school………….. 2

You have no qualifications but continued in education until 4 What is your nationality ? the end of middle school or later………….……………………… 3

French Primary school certificate (CEP)…………………………….. 4 - You are French by birth……………………………..… 1 - You became a French citizen (for example : Middle-school diploma (BEPC, Brevet Elémentaire, brevet by naturalization, by voluntary oath when you came of age)………………. 2 des collèges, DNB)………… ………………………...…….…….. 5

Vocational high-school diploma (CAP, BEP) or equivalent… 6 Please give your nationality at birth :

General or Technological Baccalaureate (Brevet Supérieur,

Capacité en Droit, DAEU, ESEU)………………………………... 7

Foreign……………………………………………………….… 3 Vocational Baccalaureate (Brevet Professionnel, Brevet de Please give your nationality : Technicien, Brevet d’Enseignement) or équivalent……….… 8

Baccalaureate + 2 years of higher education (BTS, DUT, DEUG, DEUST, 2-year health or social diploma) or equivalent……..…… 9 5 Are you enrolled in an educational institution in this Baccalaureate + 3 or 4 years of higher education (Bachelor’s academic year ? Degree, Vocational Degree, Masters) or equivalent……..….. 10 Including apprenticeships and higher education. Baccalaureate + 5 years of higher education (Masters, DEA, DESS, Yes 1 No 2 Grande Ecole diploma, PhD in health)…………………...….…... 11

Research PhD (other than in health)..………………………... 12 If yes, where is this educational institution located ?

In your municipality of residence (or in the same arrondissement 11 for Paris, Lyon, Marseille)………………………..………... 1 What is your main status ? Please tick one box only. In another municipality (or another arrondissement)……….. 2 In employment (as employee or self-employed, Please write in this other municipality : Including helping someone in his or her work)

tick, then go to question 18.….…………….…………….…………..…. 1

Apprenticeship under contract or as paid intern Municipality (and arrondissement [distric] for Paris, Lyon and Marseille département n° DOM tick, then go to question 18………………………………………... 2 6 Student (in school or higher education) or unpaid intern……… 3 Where were you living on 1 January 20xx ? Unemployed (registered or not with Pôle Emploi [French This question does not apply to children born after that date. employment agency])………………………………..………... 4

In the same dwelling as now…………………………………. 1 Retired or preretired (formerly in paid employment or self-

employment)…………………………………..…..……………...…. 5 In another dwelling in the same municipality (or of the same arrondissement for Paris, Lyon, Marseille).. 2 Housewife or househusband.……………..………………… 6

Other……………………………….….………..……….……..…. 7 In another municipality (or in another arrondissement for Paris, Lyon, Marseille)…….. 3 12 Please write in this other municipality : Are you currently working ?

If you have an occasional job or a job of very short duration, or if you are in apprenticeship or in

a paid internship, tick “Yes”. If you are on sick leave or maternity leave, tick “Yes”. Municipality (and arrondissement for Paris, Lyon, Marseille) 18 Yes tick, then go to question ……………………….. 1

13 No tick, then go to question ……………………….……. 2 département number département Country (DOM) territory (for French overseas territories TOMs) Continue on next page and do not forget to sign

13 23 If you are not currently working, please answer Is your job :

questions 14 to 17 full-time ? …………….. 1 part-time ?………..….. 2

14 24 Have you already worked ? Are you :

1 Yes ……………………………………………………………….... self-employed, freelance ? ……....…………………………………. 1 17 No tick, then go to question ..…………………..….…. 2 a salaried manager CEO, minority manager of SARL (limited liability company)……………………………………….. 2 15 Were you : a paid employee ? Æ tick, then go to question 27 …………..….. 3 a paid employee or a paid intern ?.……………………………….... 1 helping a person in his or her work in an unpaid capacity ? ..…... 4 self-employed, freelance ?…………………..………………….. 2

helping a person in his or her work in an unpaid capacity ..………. 3 25 If you are self-employed or a business owner, how 16 many people do you employ ? What was your principal occupation ?

None 0 1 to 9 1 10 or more 2

26 17 If you are not an employee, what is your occupation ?

Are you currently looking for work ?

Yes, I have been looking for less than a year ……….……………... 1 Please be specific. For example : “FLORIST” (not “RETAILLER”).

Yes, I have been looking for a year or more..…………….……. 2

No……………………………………………….…………………... 3

27 The remainder of the questionnaire concerns employees 18 The remainder of the questionnaire concerns people currently in employment. 28 If you hold several jobs, please describe your main job only What kind of work or employment contract do you in questions 19 à 31 . have ?

Open-ended employment, CDI (contrat à durée indéterminée), 19 What is the name of the entity that employs you or the tenured employee, tenured civil servant…………….……………. 1 entity that you run ? Apprenticeship contract..…………….……………………….... 2 If you are a temp worker, please give the name of the entity to which you Assigned by a temp agency………………………………………… 3 have been assigned. If you are self-employed, please write in the name of Paid internship in a firm.…………….……………………….... 4

your business or your own name. Government-subsidized work contract (example : Emploi Jeune, CES, contrat de qualification)……………. 5

Other fixed-term employment, CDD (contrat à durée déterminée), short-term contract, seasonal work, contract worker, etc……….. 6 20 What does the entity do ? 29 In your job, are you : Be very specific (for example : « MOTOR-VEHICLE REPAIR ») If the entity is a farming concern, please also state its specialisation (vineyard, a labourer, unskilled worker ?.. ………………………….……...…. 1

poultry farming, etc.). a skilled or high-skilled manual worker, workshop technician ? …………………….………..………..… 2

a technician (of non-managerial rank) ? …………………………… 3

a Category-B civil servant ? ………………….…………….…. 4 21 What is the address of your place of work ? a foreman, administrative or business supervisor, sales Write in the place where you usually begin work representative ? …………………………………………..…..…….. 5

(example : 18, boulevard Pasteur). a Category-A civil servant ? …………………..………..……... 6 If that place is not fixed, write « varies ». an engineer, management-level employee in business firm ? ....….. 7 If you work at home, write « at home ». If you are working for a private individual, write « private individual ». a Category-C or -D civil servant ? ….………………….…..….. 8 a paid employee (for example : in an office, store, restaurant, private home) ? ……………………….……………………...…….. 9

30 What is your principal occupation ? Is it in your municipality of residence ? (or in the same arrondissement for Paris, Lyon, Marseille) Be specific. For example : « CHECKOUT ASSISTANT » (not « WHITE- COLLAR WORKER »), « HEAD OF CUSTOMER SUPPORT » (not Yes 1 No 2 « MANAGER » . If not, please write in the municipality where you work : If you are a civil servant in central government, local Government, or the public hospital system, please write in your rank (“corps”, category, etc…). municipality (and arrondissement [district] for Paris, Lyon, and Marseille)

Département number n° DOM Country Metropolitan France

22 31 What main means of transport do you usually use to go In your job, what is your main function ? to work ? Production, operation, worksite……………………………………. 1 None……………………………………………………….…….…. 1 Installation, repair, maintenance….. ………………………..…. 2 Walking……….…………………………………………….… 2 Management, accounting………………………………….……….. 3 Bicycle (including electrically assisted)…..…………..….……….... 3 Two-wheel vehicle……….………………………………..….. 4 Studies, research………………………. ………………….….... 4 Car, lorry or van………..………………………………………..….. 5 Other : sales/marketing, secretariat, logistics, etc ………..……….. 5 Public transport ………………...…………………………….. 6 Thank you for your participation

Having regard to the approval by the National Council for Statistical Information (CNIS), and in accordance with Act 51-711 of 7 June 1951 (amended), this survey, recognized as being in the public interest and for its statistical quality, is compulsory. Responses Are protected by statistical confidentiality rules and are Date : ______intended for the preparation of statistics on population an housing. Approval 2009A001EC by the Economy Ministry, valid from 2009 to 2013. In accordance with Act 2002-276 of 27 February 2002. the census survey is placed under the responsibility of INSEE and or public agencies for inter-municipal cooperation. Signature : Act 78-17 of 6 January 1978 (amended) gives the persons surveyed the right to access and correct data about them. This right can be exercised by applying to INSEE Regional Offices