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Individual form
French Republic
General Population Census of 1975

Form number 2

To fill out after the housing form (form number 1)
This form will be filled out for all people recorded in list A of the housing form including young children.

Box to be filled out be the census agent:

District number of the census _ _ _ _
Order number of the building _ _ _
Dwelling number (or mobile home number, or shared household number) _ _

City Hall Stamp

For the small boxes which have been provided for your response, put a cross in the one which corresponds to your situation.

1. First and last names


Write the last name in capital letters. A woman will also include her maiden name (example: MAURIN born ALLARD, Marie, Lucie.)

2. Address

Number ____
Street (or place name) ____

3. Sex

[] 1 Male
[] 2 Female

4. Marital Status

Put a cross in the only box which corresponds to your current situation: so, a widower (or a divorced man) who is remarried will mark the second box

[] 1 Single
[] 2 Married
[] 3 Widow(er)
[] 4 Divorced

5. Date and place of birth

Born : (day, month, year) ____
in (city): ____ (for Paris, Lyon, Marseille, specify the district)
County: ____ (country for foreigners, territory for the T.O.M.)

6. Nationality

[] 1 French by birth (including by reintegration 1
[] 2 French through naturalization, marriage, declaration
Indicate your previous nationality ____

[] 3 Foreigner
Indicate your nationality ____

7. Where were you living on January 1, 1968?

(for all people born before January 1, 1968)

If, on January 1st, 1968, you were in the military or were a boarding student or under treatment in a care facility, indicate the address of your personal residence at this date and not the address of the institution (barrack, boarding school, sanatorium, etc.)

[] 1 In the same dwelling as now
[] 2 In the same city (or the same city neighborhood for Paris, Lyon or Marseille)
[] 3 In another city (or another district for Paris, Lyon or Marseille)
Indicate this other city:

City (For Paris, Lyon, Marseille, specify the city neighborhood [arrondissement]) ____
County (Country for the foreigner, territory for the T.O.M) ____

If, on January 1, 1968, you were living abroad or in an overseas territory or department, in which year did you come (or return) to live in Metropolitan France?
19_ _

For all people 16 years of age or older
[Applies to questions 8 -18]

8. Among the following diplomas, indicate all those that you have:

a. General or secondary education

[] 1 Certificate of primary studies (C.E.P), Diploma from the end of obligatory studies (D.F.E.O).
[] 2 Elementary certification, junior high school certificate (B.E.P.C) [Brevet d'études du premier cycle], Elementary certificate (B.E.) or certificate of superior primary education (B.E.P.S.) [Brevet Européen du Premier Secours].
[] 3 High school diploma (1st part, probationary, or second part), not including the series F, G and H; superior certificate
[] 4 Diplomas of levels superior to the high school diploma (diplomas given in universities, diplomas from large specialized schools public or private, engineering schools, etc.)

b. Technical education and professional training

[] 1 Certificate of professional aptitude (C.A.P.) [Certificat d'aptitutude professionnelle] Certificate of professional education (B.E.P.) [Brevet d'études professionelles], Exam at the end of artisan's apprenticeship (E.F.A.A.) [Examen de fin d'apprentissage artisinal], Agricultural certificates (B.A.A. [Brevet d'apprentissage agricole], B.E.A. [Brevet d'enseignement agricole], B.P.A. [Brevet professionnel agricole]) Certificate at the end of the internship of the F.P.A. [Formation Professionnel des Adultes] first degree.
[] 2 Professional certificate (B.P.) [Brevet professionnel], Master's certificate, certificate at the end of the internship of the F.P.A. [Formation professionnel des adultes], 2nd degree.
[] 3 Certificate of business education (B.E.C), [Brevet d'enseignement commercial], industrial (B.E.I.) [Brevet d'enseignement industriel], social (B.E.S.) [Brevet d'enseignement social], hotel management (B.E.H.); [Brevet d'enseignement hotelier], Certificate of agricultural technical agent (B.A.T.A.) [Brevet d'agent technique agricole].
[] 4 Technician's high school diploma (series F, G or H), technician's certificate (B.T., B.T.A. [Brevet de technicien agricole], Student certified in E.N.P [Ecole nationale polytechnique] or a public technical high school, superior certificate of business education (B.S.E.C.) [Brevet supérieur d'enseignement commercial].
[] 5 Superior technician's certificate (B.T.S.), University technical diploma (D.U.T.), Graduate degree in technical studies (D.E.S.T.).
[] 6 Paramedical and social diplomas (nurse, midwife, child care, welfare, social assistant, etc.)
[] 0 Other professional diplomas. Specify ____.

9. Are you currently a high school or university student?

[] 1 Yes
[] 0 No

Do not answer "Yes" except if you are taking classes in an academic institution (including professional or technical) or a university for the normal length of an academic year.

If you are apprenticed under contract or interned at a F.P.A center, if you are not taking professional classes part-time, improvement classes by correspondence, seasonal classes, etc., answer "No".

10. At what age did you stop going regularly to an academic institution (including professional or technical or university)

____ years

Do not write anything in the grid below

[The block in the lower right corner of the page contains boxes to be marked by the census official.]

Professional activity (for all people 16 years or older)

If you are currently out of work and if you are looking for some, go directly to question 17
If you do not work anymore, go directly to question 18

11. Main profession

Indicate the profession or the career that you currently practice
(even if you still only an apprentice or if you work by helping a member of your family in his or her profession). A woman who only takes care of her home will answer "without profession".


Be specific: Examples: mechanic (automobile repairman, clothing maker, carpenter in iron, fitter in central heating, building painter, industrial designer, electrical engineer, wine-grower, driver of heavy loads, shorthand typist, whole-sale drugs, etc.

12. Do you work without pay by helping another person in his/her profession (for example a member of your family)?

[] 1 Yes
[] No

13. Do you practice your main declared profession as:

[] 2 Farmer
[] 3 Member of a free-market profession
[] 4 Employer or self-employed worker: artisan, merchant, industrial worker, etc. (working for yourself, including managers of the S.A.R.L [Société à responsabilité limitée] and people not working except on commission)
[] 5 Working at home for yourself for one (or more) companies
[] 6 Apprenticed under contract
[] 7 Paid

14. For paid workers:

a. If you are a worker, specify the qualification of your current job:

[] 1 Unskilled or specialized laborer
[] 2 Specialized worker (OS1, OS2)
[] 3 Skilled worker or highly qualified (P1, P2, P3...)

b. If you are a state employee, from a local city or a public service (E.D.F. Electricité de France, S.N.C.F, Société nationale des chemins de fer etc.) or military by career, specify your rank:
Examples: principal administration agent, administrative secretary, stationmaster of the second class, etc.

c. If you are in a different situation, specify your hierarchical position:
Examples: supervisor, head farmer, head of a department store, business director, etc.

15. If you are self-employed:

(answers 2, 3, or 4 on question 13)

Do you hire employees?
Do not count servants at home in your service. In agriculture, only count permanent paid workers.

[] Yes
How many?

[] 1 1 to 2
[] 3 3 to 5
[] 6 6 or more

[] 0 No

16. Where do you work?

a. Address of your workplace:

Number ____
Street (or place name) ____
City (for Paris, Lyon, Marseille, specify the district) ____
County: ____
If, during your work, you needed to move (situation of bus drivers in the S.N.C.F., etc.) indicate the place where you ordinarily go to start your work (train station, depot, etc.)
If you did not always go to work in the same place (the case for business travelers for example), answer "variable"

b. Name (or corporate name) of the institution (industrial, commercial, administrative, agricultural, etc.) which you are in charge of or where you are employed: ____

c. Activity of this institution:
Be specific: Examples, commerce of whole-sale wine production, retail grocery store, manufacture of steel structures, cotton mill, highway transport of passengers, truck farmer, etc.

d. Address of this institution, if it is different than the one declared in question 16a :

Number ____
Street (or place name) ____
City (for Paris, Lyon, Marseille, specify the district) ____
County: ____

17. If you are currently without work and if you are looking for some:

a. For how long have you been looking for work?

[] 1 less than 3 months
[] 2 3 to less than 6 months
[] 3 6 months to less than a year
[] 4 one year or more

b. Have you already worked?

[] Yes
[] No

c. What is your career? ____

18. If you do not work anymore:

(You are, for example, retired from public service, a retired worker, retired executive, former farmer, retired from business, etc.)

What was your principal profession? ____

For people passing through (see box C, page 3 of form number 1).
Address of the usual residence:

Number ____
Street (or place name) ____
City (for Paris, Lyon, Marseille, specify the district) ____
County: ____

Do not write anything in the grid below.

In ____
on ____ 1975
Signature of the declarant: