FORM-CI
CONFIDENTIAL
MAY 12,1980
___________-___.------------------------Surname
MAIN ACTIVITY DURING PAST 1 2 MONTHS
DURING PAST YEAR
First Name
S
STUDENT
AETLRED
Middle Name
DISABLED
OTHER
FORM-CI
CONFIDENTlAh
FORM-CI
CONFIDENTIAL
i
1
COUNTRY
DISTRICT
MINOR
n
I
I
I
SEC
IDENTIFYING NUMBER -Li
L O
HOUSEHOLD NUMBER
14
!u
SEC. 2
P
es
E
L - æ
I
fi
' V
N
S
N:ikER
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NAMEOF
INDIVIDUAL I-L
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,
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_... _ _ _ _ _
.. _ _
.-_.._. INUIVIUUAL NUMBEH WITHIN HUUStHULU
K t L A l IUNSHlr i U H t A U U F H U U b t H U l U
I
6
17
1-
SEX
AGE
I
I
I
5
I
I
20
L
r
HEAD
SPOUSE1
PARTNER
HDISP
0
0
0
MALE O
I
1
OTHER BOARDER1
REL.
REL.
0
2&
a
-
NEVER
MARRIED MARRIED
O
0
9(a) THIS HOUSEHOLD O
9
ST.PAUL
ST.GEO.
REST
0
BASS.
0
5%
&
&3
L
DIVORCED
0
o
ST.ANN.
0
ST.THOS.
0
r
t
7%
7r;
!aIRKED FOR OTHERS
TRINITY
0
8 5
9%
L
10
(a)
10
(b} GAY.
ST.O
JOHN
ST.PAUL
0
CAN.
ANT.
0
U.S.A.
D.W.I.
ANGUILLA
OTHER
L.A.
ALL
OTHER
NOT
STATED
ST.VIN.
0
JAM.
0
T&T
0
B'DOS
0
SYRIAN1
LEB.
WHITE
MIXED
OTHER
RACES
NOT
STATEC
0
0
0
0
Est
U.K.
o
ANT.
0
MON.
0
B.V.I.
0
DOM.
0
GREN.
0
ST. LUC.
0
NEGRO1
BLACK
EAST
INDIAN
CHINESE
AMERINDIAN
PORTUGUESE
0
0
0
0
0
o
o
DOM.
REP.
o
o
RETIRED
o
HAS OWN BUSiNEWFARM
UNPAtD
WORKER
0
4-5
0
WITH
PAID HELP
O
6-7
8-9
O
O
OTHER
NOT
STATED
DID
NO WORK
O
STATED
NOT
O
DISABLED
>
o
WlOUT
PAID HELP
0
10-11
O
12
O
o
a
NOTSTATEDO
O
MONT.
0
o
,
ï l
e .
CAN.
0
C
NOT STATED
ST.JOHN ST.MARY ST.PETER
0
0
0
OTHER OTHER
NOT
DOM.
CARIB. COUNT. STATED
0
0
0
0
ST.THOS
ST.JAMES
NOT STATED
ST.GEORGE
O
O
0
O
ST.ANN. ST.THOS. TRINITY CH.CH. ST.JOHN ST.MARY ST.PETER
0
0
0
0
0
0
0
U.S.A.
0
PRIV.
H'HOLD
0
2-3
0
STUDENT
o
NOT STATED Q
0
9
U.K.
l!%Ä
0
0
ST.PAUL
O
BASS.
sTdi%?'
0
0
GOVT.
O
O
O
b
83
ST.JAMES
CH.CH.
0
PRIV.'
ENTER.
O
1
O
HOME
DUTIES
NOT
STATEC
O
ABROAD 0
O
OTHERS
WANTED
SEEKING WORK AND
WORK
0
AVAILABLE
0
NOT
STATEC
O
OTHER
O
ST.THOS
ST.GEORGE
O
ST.PAUL
0
3
LEGALLY
SEP.
O
ELSEWHERE IN COUNTRY O
ST.JOHN
o
(bl
4%
b 4æ
WIDOWED
O
7
DOMESTIC
EMPLJREL.
O
0
&
o, t 20
I
b~L
47
4 3
FEMALE O
c 7@-I
v
I
MARITAL STATUS (14 YEARS AND OVER)
o
i
I
SEEKING
FIAM
O
JOB
WORKED
I
F
(IN COMPLETEI2 YEARS)
~
123
r
r
I
r
I
E
A R
L S
TOWN/
o
o
c
1:; Fil
WITHJOB
NOTWKG.
LOOKED
FORWK.
HOME
DUTIES
STUDENT
RETIRED
DISABLED
OTHER
0
0
0
0
0
0
0
&
&
4 5
%
FREE
SQUATTED
HP
RENTED
OTHER
0
0
0
O
e.
NOT
STATED
O
7 5
8 5
il&,
>
0
12
CHURCH
PRESBYI ROMAN
OF
ANGL.
BAPTIST
HINDU
GOD METHDST. MORAVN. PENT.
CONGR.
CATH.
ADVTSl
0
0
0
0
0
0
0
0
0
0
JEH. WIT. BRETH. SAL.ARMY
A.M.E.(ZION) MUSLIM MENNONITE OTHER NONE NOT STATE1
O
0
0
0
0
0
0
0
0
13Q=,
&
&
e
33
4%
Q,
20
&3
83
74
ST.PAUL
ST.JOHN
BASS.
0
ST.THOS
ST.GEORGE
O
o
7%
&
L 63
w
8 5
$&,
7 3
8,
ST.JAMES
o
$2
NOT STATED
O
ST.JOHN ST.MARY ST.PETER
0
0
0
ST.GEO.
REST
0
ST.PAUL
0
ST.ANN.
0
1
2
0
3
4
5
6
7
8
0
0
0
0
0
0
0
1980
0
NOT
STATEC
0
15
0
ST.THOS.
0
TRINITY
0
CH.CH.
0
9 OR
MORE
I6 BEFORE
1970
0
17
1970-72
O
1973-74
0
1975
0
1976
0
1977
0
1978 '
0
1979
0
NONE
NSRY.1
INFANT
PRIMARY
SECOND.
ORCOMP.
MULTI
HIGH
OTHER
SECOND.
UNIV.
OTHER
#
0
0
0
0
0
0
0
'*
FULL TIME
STUD ENT
O
PART TIME
STUDENT
O
NOT
APPLICABLE
O
NSRY.1
INFANT
PRIMARY
SECOND.
ORCOMP.
MULTI
HIGH
OTHER
SECOND.
0
0
0
0
0
0
1-2
3-4
5-6
7
o
8
o
NOT
STATEC
O
MOT
STATED
O
*n
13
(a) NONE
0
,
UNIV.
OTHER
0
NOT
STATED
O
.fi
IJ
O
.-. o
Ih)
o
o
0
19
(c)
0
GCE(O)5/
NONE
LEAVING
SCLZLL
CH%
SSPE
' P*-l
O
O
CXC(B) 1-3
O
1
I
'
O
O
10
11+
NOT
STATEC
o
o
o
OTHER
NOT
STATEC
GCE(A)
GC$A)1
O
9
O
2+
DIP.
O
DEG.
O
C
>
O
3a
OWNED
LEASED
RENTED
0
0
0
$%!ED
FpdEvd
P'itD
INTO DWEL. INTOYD. INTO DWEL.
O
0
0
39(a)
lm
SHARED
NONE
1980
1979
1978
o
o
~
I
22 PERIOD OF TRAINING
(FORPERSONSWHOSETRAlNINGHASBEENCOMPLETED)
-
, :?
22
k
o,
0
UNDER
%-1
-c>
o
.........
o
o
o
o
1-1%
1%-2
2-2%
2K-j
34%
3%4
44%
4KYRS
O
t 2>
LIGHTING
44(a)
ELEC.
KEROSENE
O
O
. THIS HOUSEHOLD
.
NOT STATED
O
'2 'Es E E E E YRS.
~
43(a)
O
COMPLETED
O
1970-77
&EF
o
BRICK
O
o
ST.PAUL
0
c
0O
0
NOG
ADOBE
O
O
OTHER
0
o
&Y&
&
NOT
STATEO
O
~
WOOD
C&&TE
O
NOT
STATED
O
NOTSTATED
O
OTHER
O
72DOVER
COOKING-
GAS
0
ELSEWHERgN COUNTRY
u
ELEC.
CHAR
KERO.
OTHER/
NONE
0
0
0
0
ABEAD
u
ST.GEORGE
O
ST.THOS.
0
>
EARLIER
1960 OR
1961-89
I(b)
ST.ANN.
0
O
TOSEWER OTHER
o
b &
ST.JOHN
ST.GEO.
REST
0
NOT
STATEO
W.C. NOT
TOSEWER
o
0
CONCRETE STONE
42
c)
O
PIT
a
STATED
O
OTHER
0
0
WOOD
WOOD
CXC(G1 1-3
B E G TRAINED
PUB.
STAND
PIPE
0
41
BASS.
0
ACQUIRED
PRIV.
CATCHM.
NOT PIPED
O
W.C.
NOT
SHARED
44(b) ST.PAUL
I
0
TRINITY
0
ST.THOS
ST.JAMES
NOTSTATED
O
0
O
CH.CH. ST.JOHN ST.MARY ST.PETER
0
0
0
0
INSTRUCTIONS
1. Please use the #2 black-ad pencif supplied when marking your answers to b e questions on this form.
DO NOT USE INK, BALLPOINT PEN, OR COLORED PENCIL. If you make a mistake, erase cleanly
and then fill in the answer space you want. Be sure to fill a response position ( 0 1 for each question
where the question applies to the individual. Each answer space you mark should be filled in
completely with a black mark, the same as shown in the SAMPLE QUESTION.
SAMPLE QUESTION
EXAMPLE
OF HOW
TO ANSWER
LESS THAN
AMONTHAGO .ID
THE QUESTIONS
~
~
~ a~
~
y
G
0
MAKE NO EXTRANEOUS MARKS O F ANY KIND ON THE FORM
2.Do not mark or write in the shaded areas. The areas will be marked in the central office.
3. When YOU have finished questions 1 through 22, carefully fold at perforation and continue with
questions 23 through 46.
4. Try to make your marks as shown here:
Do not make them too light
too short
too long
or too thin
-
8
An ideal mark
A readable mark
Too light or poorly erased
Mark too short
Mark too long
Too thin to read