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
Sex
2
Date and place of birth
Male
1
Female
Born :
day
7
2
month
year
in :
3
n° DOM
Are you living in a union ?
9
Are you… ?
Country (if born abroad)
territory (for French overseas territories TOMs)
10
Primary school certificate (CEP)……………………………..
Vocational high-school diploma (CAP, BEP) or equivalent…
3
Vocational Baccalaureate (Brevet Professionnel, Brevet de
Technicien, Brevet d’Enseignement) or équivalent……….…
Please give
your nationality :
Baccalaureate + 3 or 4 years of higher education (Bachelor’s
Degree, Vocational Degree, Masters) or equivalent……..…..
Including apprenticeships and higher education.
No
Research PhD (other than in health)..………………………...
If yes, where is this educational institution located ?
In your municipality of residence (or in the same arrondissement
for Paris, Lyon, Marseille)………………………..………...
1
In another municipality (or another arrondissement)………..
11
Please write in this other municipality :
Municipality (and arrondissement [distric] for Paris, Lyon and Marseille département
6
n° DOM
Where were you living on 1 January 20xx ?
This question does not apply to children born after that date.
In the same dwelling as now………………………………….
In another dwelling in the same municipality
(or of the same arrondissement for Paris, Lyon, Marseille)..
1
2
In another municipality
(or in another arrondissement for Paris, Lyon, Marseille)……..
Please write in this other municipality :
3
12
5
7
9
11
12
What is your main status ?
Please tick one box only.
In employment (as employee or self-employed,
Including helping someone in his or her work)
tick, then go to question 18.….…………….…………….…………..….
Apprenticeship under contract or as paid intern
tick, then go to question 18………………………………………...
2
Student (in school or higher education) or unpaid intern………
Unemployed (registered or not with Pôle Emploi [French
4
employment agency])………………………………..………...
Retired or preretired (formerly in paid employment or selfemployment)…………………………………..…..……………...….
Housewife or househusband.……………..…………………
6
Other……………………………….….………..……….……..….
2
3
10
Baccalaureate + 5 years of higher education (Masters, DEA, DESS,
Grande Ecole diploma, PhD in health)…………………...….…...
2
1
8
Baccalaureate + 2 years of higher education (BTS, DUT, DEUG,
DEUST, 2-year health or social diploma) or equivalent……..……
Are you enrolled in an educational institution in this
academic year ?
5
6
General or Technological Baccalaureate (Brevet Supérieur,
Capacité en Droit, DAEU, ESEU)………………………………...
Foreign……………………………………………………….…
2
4
Middle-school diploma (BEPC, Brevet Elémentaire, brevet
des collèges, DNB)………… ………………………...…….……..
2
2
2
You have no qualifications but continued in education until
the end of middle school or later………….………………………
Please give your nationality at birth :
1
No
What qualifications do you have ?
You have no qualifications and left education at the end of
primary school or before the end of middle school…………..
What is your nationality ?
Yes
1
You did not go to school or left before the end of
primary school ……………………………………………..….….
If you were born abroad, in what year did you arrive in
France ?
French
- You are French by birth……………………………..…
1
- You became a French citizen (for example :
by naturalization, by voluntary oath when you came of age)……………….
5
Yes
Married…………… 1
In a civil union (PACS)…………..
In a non-marital or common-law union………………..….…. 3
Widowed…………. 4
Divorced………….………………..
Single…………………………………………………..……. 6
year
4
The remainder of the questionnaire
concerns people aged 14 and over.
8
municipality (and arrondissement for Paris, Lyon, Marseille)
Département number
Métropolitan France
municipality
1
3
5
7
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 district for Paris, Lyon, Marseille)
département number
département
(DOM)
Country
territory (for French overseas territories TOMs)
Yes
No
tick, then go to question
tick, then go to question
18………………………..
1
13……………………….…….
2 Continue on next page and do not forget to sign
13
14
If you are not currently working, please answer
questions 14 to 17
23
Have you already worked ?
24
full-time ? ……………..
Yes ………………………………………………………………....
No
tick, then go to question 17..…………………..….….
2
15
1
part-time ?………..…..
2
self-employed, freelance ? ……....………………………………….
1
Are you :
Were you :
a paid employee ? Æ tick, then go to question
1
3
25
What was your principal occupation ?
26
Are you currently looking for work ?
Yes, I have been looking for less than a year ……….……………...
Yes, I have been looking for a year or more..…………….…….
2
No……………………………………………….…………………...
18
The remainder of the questionnaire concerns people
currently in employment.
If you are self-employed or a business owner, how
many people do you employ ?
What does the entity do ?
10 or more
2
If you are not an employee, what is your occupation ?
What kind of work or employment contract do you
have ?
Open-ended employment, CDI (contrat à durée indéterminée),
tenured employee, tenured civil servant…………….…………….
Apprenticeship contract..…………….………………………....
2
Assigned by a temp agency…………………………………………
Paid internship in a firm.…………….……………………….... 4
Government-subsidized work contract
(example : Emploi Jeune, CES, contrat de qualification)…………….
Other fixed-term employment, CDD (contrat à durée déterminée),
short-term contract, seasonal work, contract worker, etc………..
6
29
30
1
3
5
In your job, are you :
a labourer, unskilled worker ?.. ………………………….……...….
a skilled or high-skilled manual worker,
2
workshop technician ? …………………….………..………..…
a technician (of non-managerial rank) ? ……………………………
a Category-B civil servant ? ………………….…………….….
4
a foreman, administrative or business supervisor, sales
representative ? …………………………………………..…..……..
a Category-A civil servant ? …………………..………..……...
6
an engineer, management-level employee in business firm ? ....…..
a Category-C or -D civil servant ? ….………………….…..…..
8
a paid employee (for example : in an office, store, restaurant,
private home) ? ……………………….……………………...……..
Is it in your municipality of residence ?
(or in the same arrondissement for Paris, Lyon, Marseille)
1
3
5
7
9
What is your principal occupation ?
Be specific. For example : « CHECKOUT ASSISTANT » (not « WHITECOLLAR WORKER »), « HEAD OF CUSTOMER SUPPORT » (not
« 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…).
Yes
1
No
2
If not, please write in the municipality where you work :
municipality (and arrondissement [district] for Paris, Lyon, and Marseille)
22
1
28
Write in the place where you usually begin work
(example : 18, boulevard Pasteur).
If that place is not fixed, write « varies ».
If you work at home, write « at home ».
If you are working for a private individual, write « private individual ».
n° DOM
1 to 9
The remainder of the questionnaire concerns employees
What is the address of your place of work ?
Département number
Metropolitan France
0
27
What is the name of the entity that employs you or the
entity that you run ?
Be very specific (for example : « MOTOR-VEHICLE REPAIR ») If the
entity is a farming concern, please also state its specialisation (vineyard,
poultry farming, etc.).
21
3
4
3
If you are a temp worker, please give the name of the entity to which you
have been assigned. If you are self-employed, please write in the name of
your business or your own name.
20
2
…………..…..
Please be specific. For example : “FLORIST” (not “RETAILLER”).
1
If you hold several jobs, please describe your main job only
19 à 31 .
in questions
19
27
helping a person in his or her work in an unpaid capacity ? ..…...
None
17
1
a salaried manager CEO, minority manager of SARL
(limited liability company)………………………………………..
a paid employee or a paid intern ?.………………………………....
self-employed, freelance ?…………………..…………………..
2
helping a person in his or her work in an unpaid capacity ..……….
16
Is your job :
Country
What main means of transport do you usually use to go
to work ?
None……………………………………………………….…….….
Walking……….…………………………………………….…
2
Bicycle (including electrically assisted)…..…………..….………....
Two-wheel vehicle……….………………………………..….. 4
Car, lorry or van………..………………………………………..…..
Public transport ………………...……………………………..
6
1
3
5
31
In your job, what is your main function ?
Production, operation, worksite…………………………………….
Installation, repair, maintenance….. ………………………..….
2
Management, accounting………………………………….………..
Studies, research………………………. ………………….…....
4
Other : sales/marketing, secretariat, logistics, etc ………..………..
1
3
5
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
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 municipalities or public agencies for inter-municipal cooperation.
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
Date : ____________________
Signature :