Population Census - XXXX Individual form

Example : DUPAS, épouse MAURIN Box to completed by the enumerator Last name :

First name : Address : departement municipality Imprimé n° 3A

1 Sex Male 1 Female 2 7 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 : day month year 9 Are you ? In a civil solidarity in : • Married...... 1 • pactIn a civil (PACS)solidarity pact (PACS)...... 2 municipality (and arrondissement [] for Paris, , ) • In a non-marital or common-law union...... 3

• Widowed...... 4 • Divorced...... 5 departement n° DOM (if born abroad), (for French overseas collectivities COM’s) • Single...... 6 If you were born abroad, in what year did you 3 10 What qualification do you have ? arrive in France ? • You did not go to school or left before the end of primary school...... 01 year • You have no qualification and left education at the end 4 What is your nationality ? of primary school or before the end of middle school...... 02 • French • You have no qualification but continued in education until the end of middle school or later...... 03 – Your are French by birth...... 1 • Primary school certificate (CEP)...... 11 – You became a French citizen (for example : • Middle-school diploma (BEPC, Brevet Elémentaire, by naturalization, by voluntary oath when you came of age). 2 brevet des collèges, DNB)...... 12 Please give your nationality at birth : • Vocational high-school diploma (CAP, BEP) or equivalent...... 13 • General or Technological Baccalaureate (Brevet Supérieur, Capacité en Droit, DAEU, ESEU)...... 14 • Foreign...... 3 • Vocational Baccalaureate (Brevet Professionnel, Brevet de Technicien, Please give Brevet d’Enseignement) or equivalent...... 15 your nationality : • Baccalaureate + 2 years of higher education (BTS, DUT, DEUG, DEUST, 2-year health or social diploma) or equivalent...... 16 5 Are you enrolled in a educational institution COMPREHENSION• Baccalaureate + 3 or 4 years of higher education (Bachelor’s in this academic year ? Degreee, Vocational Degree, Masters) or equivalent...... 17 Including apprenticeships and higher education. • Baccalaureate + 5 years of higher education (Masters, DEA, DESS, Grande Ecole diploma, PhD in health...... 18 Yes 1 No 2 • Research PhD (other than in health)...... 19 If yes, where is this educational institution located ? (orLA in the same • In your municipality of residence 11 What is your main status ? arrondissement [district] for Paris, Lyon, Marseille)...... 1 Tick one box only. • In another municipality (or in another ...... 2 • In employment (as employee or self-employed, including arrondissement [district] for Paris, Lyon, Marseille) A helping someone in his or her work) Please write in this other municipality : ➩ tick, then go to question 18 ...... 1 • Apprenticeship under contract or as paid intern

municipality (and arrondissement [district] for Paris, Lyon, Marseille) departement n° DOM ➩ tick, then go to question 18 ...... 2 • Student (in school or higher education) or unpaid intern... 3 Where were you living on 1 January XXXX ? 6 • Unemployed (registred or not with Pôle Emploi)...... 4 This question does not apply to children born after. • Retired or preretired • In the same dwelling as now...... 1 (formely in paid employment or self-employment)...... 5 • In another dwelling in the same municipality AIDE • Housewife or househusband...... 6 (or in the same arrondissement for Paris, Lyon, Marseille).... 2 • Other...... 7 • In another municipality (or in another arrondissement for Paris, Lyon, Marseille)...... 3 12 Are you currently working ? Please write in this other municipality : If you have an occasional job or a job of very court duration, or if you are in apprenticeship or in a paid intership,tick « Yes ». If you are on sick leave or maternity leave, tick « Yes ». Municipality (and arrondissement for Paris, Lyon, Marseille) • Yes ➩ tick, then go to question 18 ...... 1 • No ➩ tick, then go to question 13 ...... 2 departement n° DOM country, territory (for French overseas collectivities COM’s) Continue on next page and do not forget to sign ➜ 13 If you are not currently working, please answer 23 Is your job :

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

14 Have you already worked ? 24 Are you : • Yes...... 1 • self-employed, freelance ?...... 1 • No ➩ tick, then go to question 17 ...... 2 • a salaried manager CEO, minority manager of SARL (limited liability company) ?...... 2 15 Were you : • a paid employee ? ➩ tick, then go to question 27 ...... 3 • a paid employee or a paid intern ?...... 1 • helping a person in his or her work • self-employed, freelance ?...... 2 in a unpaid capacity...... 4 • helping a person in his or her work in an unpaid capacity...... 3 25 If you are self-employed or a business owner, how many people do you employ ? 16 What was your principal occupation ? None 0 1 to 9 1 10 or more 2

26 If you are not an employee, what is your 17 Are you currently looking for work ? occupation ? • Yes, I have been looking for less than a year...... 1 Please be specific. For example : « FLORIST » (not « RETAILER »). • 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. If you hold several jobs, please describe your main job 28 What kind of work or employment contract do you have ? only in questions 19 to 31 . • Open-ended employment, CDI (contrat à durée indéterminée), tenured employee, tenured civil servant...... 1 19 What is the name of the entity that employs • Apprenticeship contract...... 2 you or the entity that you run ? • Assigned by a temp agency...... 3 If you are a temp worker, please give the name of the entity to • Paid intership in a firm...... 4 which you have been assigned. If you are self-employed, please • Government-subsidized work contract (example contrat unique write in the name of your business or your own name. d’insertion, d’accompagnement dans l’emploi, avenir, etc.)...... 5 • Other fixed-term employment, CDD (contrat à durée déterminée), short-term contract, seasonal work, contract worker, etc...... 6 20 What does the entity does ? Be very specific (for example : « MOTOR-VEHICLE REPAIR »). 29 In your job, are you : If the entity is a farming concern, please also state its • a labourer, unskilled worker ?...... 1

specialisation (vineyard, poultry farming, etc.). • a skilled or high-skilled manual worker, 2018-03-BIA

workshop technician ?...... 2 • a technician (of non-managerial rank) ?...... 3

• a Category-B civil servant ?...... 4 COGETEFI What is the address of your place of work ? 21 • a foreman, administrative or business supervisor,

Write in the place where you usually begin work (example : Groupe 18, boulevard Pasteur). sales representative ?...... 5 If that place is not fixed, write « varies ». COMPREHENSION • a Category-A civil servant ?...... 6 If you work at home, write « at home ». If you work for a private individual, write « private individual ». • an engineer, management-level employee in business firm ?...... 7 • a Category-C civil servant ?...... 8 • a paid employee (for example : in an office, store, LA restaurant, private home) ?...... 9 Is it in your municipality of residence ? 30 What is your principal occupation ? (or in the same arrondissement for Paris, Lyon, Marseille) Be specific. For example : « CHECKOUT ASSISTANT » (not « WHITE- Yes 1 ANo 2 COLLAR WORKER »), « HEAD OF CUSTOMER SUPPORT » (not If no, please write the municipality where you work : « MANAGER »). 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 for Paris, Lyon, Marseille)

departement n° DOM country

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

Thank you for your participation

Having regard to the approval by the National Council for Statistical Information (CNIS), this survey, recognized as being in the public interest and for its statistical quality, is compulsory, in accordance with Act 51-711 of 7 June 1951 (amended). Approval n° 2018A001EC by the Economy and Finances Ministry, valid from 2018 to 2022. Date : ...... In accordance with Act 51-711 of 7 June 1951 (amended) responses are protected by statistical confidentiality rules and are intended for Insee. Act 78-17 of 6 January 1978 (amended) gives the personnes surveyed the right to access and correct data about them. This right can be exercised by appling to Signature : INSEE Régional Offices.