Confidential: The data given in this questionnaire is for statistical purposes only.
Dear Sir/Madam,
This is a questionnaire for the 1995 population and housing census, designated for the inhabitants of this apartment. An explanation sheet is enclosed to help you with the questionnaire.
Please write your answers clearly, within the given space. For those answers to be answered by marking the square, please do so by writing only an X in the box, next to the appropriate answer.
The census-taker will return within two weeks to collect the questionnaire. If any clarification is needed he/she will do so at that time.
In case the questionnaire is insufficient for all those living in the apartment, the census-taker will provide you with an additional form.
Thank you for your cooperation.
[Geographical information about the location of the dwellings numerated is located at the top of this page (p.49).]
List of people residing in the apartment
Please list everyone who resided in this apartment, on a regular basis, on Saturday night, November 4, 1995.
Telephone number in the apartment (should clarifications be needed): _ _ _ _ _ _ _ _ _
[Space is provided for responses to the following items for each person]
____ First name
Second address (should it exist): only for those who spent most of the last month's nights at another address:
____ Street/Neighborhood
____ House No.
A baby born before Saturday night, 4 November, 1995.
A new immigrant, who arrived in Israel before Saturday night, November 4, 1995.
An Israeli citizen living abroad for less than a year.
A tourist or a temporary resident who has been in the country for over a year.
A person deceased after Saturday night, November 4, 1995.
A person on holiday, in reserve army duty, in a general hospital or a detention center.
A person residing in an institution such as senior citizens' home, nursing home for the chronically ill, mental asylum, prison.
Part A: Details of all those living in the apartment
First [person] on the list of people residing in the apartment
____ First name
____ Father's name
_ _ _ _ _ _ _ _ _ I.D. Number (to be taken from I.D. card)
1. Your relationship to the first person [above]:
[] 2. Wife/husband
[] 3. Son/daughter
[] 4. Father/mother
[] 5. Sister/brother
[] 6. Sister/brother-in-law
[] 7. Son/daughter-in-law
[] 8. Mother/father-in-law
[] 9. Grandson/granddaughter
[] 10. Other relation; please specify ____
[] 11. No relation; please specify ____
3. Birth date
_ _ Month
_ _ Day
4. Personal status
[] 2. Divorced
[] 3. Widowed
[] 4. Single
5. Country of birth (as per current boundaries) and year of immigration
[] 2. Ukraine
[] 3. Morocco
[] 4. Iraq
[] 5. Poland
[] 6. Rumania
[] 7. Yemen
[] Other country, please specify ____
[] 2. Ukraine
[] 3. Morocco
[] 4. Iraq
[] 5. Poland
[] 6. Rumania
[] 7. Yemen
[] Other country, please specify ____
Country of birth:
[] 3. Morocco
[] 4. Iraq
[] 5. Poland
[] 6. Rumania
[] 7. Yemen
[] Other country, please specify ____
[p.51]
Enclosed are additional questions directed to every fifth family in the country
Part C: Includes questions regarding education, work, births, etc. This part includes two pages for everyone 15 years old or older prior to November 4, 1995 (anyone born before November 4, 1980).
Please make certain you answer all of the questions.
Use the explanation sheet attached to the questionnaire. Should you still need clarifications after reading the explanation sheet, please ask the census-taker.
We are all part of the census.
[p.52]
Part B: Living conditions
[Questions 6-13]
6. How many rooms are occupied by your family?
Do not include: kitchen, bathrooms and rooms used for business only.
[] 1. 1 room
[] 2. 1.5 rooms
[] 3. 2 rooms
[] 4. 2.5 rooms
[] 5. 3 rooms
[] 6. 3.5 rooms
[] 7. 4 rooms
[] 8. 4.5 rooms
[] 9. 5 rooms
[] 10. 5.5 rooms
[] 11. 6 rooms or more
7. When was the construction of this apartment completed?
If the exact year is not known, estimate the date and indicate such.
[] 1. 1947 or earlier
[] 2. 1948-1954
[] 3. 1955-1964
[] 4. 1965- 1974
[] 5. 1975-1984
[] 6. 1985-1989
[] 7. 1990
[] 8. 1991
[] 9. 1992
[] 10. 1993
[] 11. 1994
[] 12. 1995
8. Is this your own apartment or do you rent it?
[] 2. We pay 'key' money for the apartment
[] 3. We pay monthly rent (not 'key' money)
[] 4. None of the above; please clarify and move to question 10 [skip question 9]: ____
9. Who do you rent the apartment from?
[] 1. A private landlord (including a relative)
[] 2. A public company (such as Amidar, Amigur, Prazot, Halamish)
[] 3. None of the above; please clarify ____
10. Does this apartment have a bath or a shower?
[] 2. It only has a shower
[] 3. It has neither a bath nor a shower
11. Do you have the following items at your disposal?
[] 2. No
[] 2. No
[] 2. No
[] 2. No
[] 2. No
[] 2. No
[] 2. No
[] 2. No
12. Do you have a car at your disposal?
[] 1. No car; mark X and go on to part C on the next page (p.7) [skip question 13]
[] 2. 1 car
[] 3. 2 cars
[] 4. 3 cars and more; specify how many ____
13. Who owns the car?
[] 1. We own the car (all the cars)
[] 2. Owned by the employer or by the company
[] 3. Some owned by us some by employer or company
[] 4. Other; please specify ____
Part C: Anyone 15 years and older is requested to fill-in both pages
[Questions 14-38 were asked of people 15 years or older.]
14. Do you or did you attend school?
[] 1. I presently attend school
[] 2. Attended school in the past but not presently
[] 3. Did not attend school at all; mark X and move to question 17
[Questions 15-16 were asked of persons age 15+ who presently attend school or attended school in the past, per question 14]
15. How many years of schooling did you have? Please answer all questions:
If you didn't study [just] mark X. If you studied write the number of years.
____ A. Elementary school, junior high school: including Heder, Talmud Torah, Khutab
____ B. Vocational or agricultural high school: including yeshiva, high school vocational trend (including vocational yeshiva high school, apprenticeship school, industrial school).
____ C. High School: including yeshiva high school, "Little Yeshiva," and "external" school which prepares for matriculation exams.
____ D. Yeshiva ("big"): with the exception of high school yeshiva or "little yeshiva"
____ E. Higher, non-academic, education such as: technicians' schools, teachers' seminar, nurses' school.
____ F. Higher, academic education: University, Technion etc.
____ G. Other school: please specify ____
16. What is the highest diploma (or degree) you achieved during your studies?
[] 1. I did not receive any diploma
[] 2. Elementary or junior high school diploma
[] 3. High school diploma, which is not a matriculation certificate
[] 4. Matriculation certificate
[] 5. Higher education, non academic diploma, such as: teachers' certificate, technician, nurse
[] 6. First academic degree, B.A. or parallel degree
[] 7. Second academic degree, M.A. or parallel degree
[] 8. Third academic degree, Ph.D. or parallel degree
[] 9. Other degrees; please specify ____
Place of residence
[Questions 17-18]
17. During which year did you move to the town/place you are presently living in?
[] 2. Does not live in this town from birth. Year moved to this town: 19 _ _
18. What was your permanent address 5 years ago, namely in November 1990?
[] 2. A different address, in this town/place; please specify
___ House number
___ Street/neighborhood
___ House number
Marriages and births
[Questions 19-20]
19. Did you ever marry?
[] 2. I married once in 19 _ _
[] 3. I married more than once
[] The first time in 19_ _
20. Did you bear any children?
[Question 20 was asked of women age 15+]
Please include any children born alive, even if they are no longer alive.
[] 1. I did not bear any children
[] 2. I had children. Please specify the number of children: _ _
21. Did you work last week for even one hour? (the week ending last Saturday)
[] 1. I was in the regular (Keva) military service; please mark X and proceed to question 34 [skip questions 22-33]
[] 2. I was in the army (not including reserve duty); please mark X and proceed to question 24 [skip questions 22-23]
[] 3. I worked; please mark X and proceed to question 24 [skip questions 22-23]
[] 4. I did not work and was neither in compulsory service nor in the regular army; please mark X and proceed to question 22.
[Questions 22-23 were asked of persons age 15+ who did not work and were neither in compulsory service nor in the regular army last week, per question 21]
22. Do you have a job or business (including a farm) from which you have been absent all of last week because of an illness, holiday, reserve duty, or any other reason?
[] 2. No
23. Did you actively look for work over the last four weeks?
[] 1. Yes
[] 2. No
24. Over the last 12 months, how many months did you work in all places of employment (not including military service of any kind)?
A month's work is any month during which you worked at least one week. Please also include those months you were on paid leave because of a holiday, birth leave or reserve duty.
[] 1. I haven't worked in Israel at all during the last 12 months; please mark X and proceed to question 37 [skip questions 25-36]
[] 2. I have worked in Israel during the entire last 12 months.
[] 3. I have worked in Israel for less than 12 months. I have worked [specify how many] months: _ _
[Questions 25-33 were asked of persons age 15+ who were not in regular military service last week and worked in Israel at any time during the last 12 months, per questions 21, 24]
25. How many hours per week did you generally work, in all places of employment? Hours a week: _ _
Details on work last week
[Questions 26-33]
If you worked last week in more than one place of employment, you should refer to your principal place of work where you worked most of the week. If you did not work last week, you should refer to your last place of employment in Israel over the past 12 months.
26. Place of employment (factory, business, institution or employee): ____
27. Employment address
____ Street/Neighborhood (or nearby landmark)
____ House number
28. Place of work's main activity (a description of the activity, products, or services): ____
29. Name the department or division in which you were employed (if exists): ____
30. Describe your work:
31. What is your status at this place of employment?
[] 2. Self-employed, employing no workers
[] 3. Self-employed employing 1-2 workers
[] 4. Self-employed employing 3-9 or more employees
[] 5. Self-employed employing 10 or more employees
[] 6. Member of a cooperative
[] 7. Kibbutz member (who is not a waged worker)
[] 8. Family member working without pay in family's business or farm
32. How did you arrive at work most days last week?
[] 1. I worked at home; mark X and proceed to question 34 [skip question 33]
[] 2. I walked
[] 3. I rode a bicycle
[] 4. I used a motorcycle, motor scooter, motorbike, etc
[] 5. By transportation organized by my place of work
[] 6. By private or commercial car, as a driver
[] 7. By private or commercial car, as a passenger
[] 8. Public bus, using one bus-line only
[] 9. Public bus, using more than one bus-line
[] 10. I took the train
[] 11. By "sherut" taxi
[] 12. Other kind of vehicle; specify ____
33. At what time did you leave for work, on most days last week (or last week during which you worked)?
_ _ Minutes
[] A.M.
[] P.M.
Income from a salary, as member of a cooperative or as a professional soldier
[Questions 34-35]
34. What was your gross income (before deductions) from wages for the month of September 1995?
Please include wages from all the places of work in Israel, where you were employed. Please copy the gross salary from your pay slip (round it off to the nearest shekel).
[] If you had no such income mark X and proceed to question 36 [skip question 35]
[] Gross, I.S.: _ _ _ _ _ _
[] Net (if gross is unknown), I.S.: _ _ _ _ _ _
35. For how many workdays were you paid during the month of September 1995?
[] 1. For the entire month
[] 2. For part of the month -- days: _ _
Income from self-employed work or as a farm owner
[Question 36 were asked of persons age 15+ who have worked during the past 12 months.]
36. What was your gross income from your work as self-employed or a farm owner?
A. Gross income for September 1995.
[] If you had no income please mark X
[] If you had no income please mark X
Income not derived from work
[Questions 37-38 were asked of persons age 15+.]
37. Did you receive any National Security annuities during September, 1995?
A. National Security children's pay
[] 2. No
[] 2. No
[] 2. No
38. Did you, during September 1995, have income from the following sources?
A. Pension from a place of work or a Kupat Tagmulim in Israel.
[] 2. No
[] 2. No
[] 2. No