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[The individual forms are the same for municipalities under 10,000 persons and municipalities of 10,000 or more.]


2006 Population Census

Dwelling Form

Your answer is important

Census population surveys are now carried out each year for part of the population. This year it affects you.

From now on, economic and social actors will have recent population and housing information available to them every year.

It is useful to everyone to better understand the changes in French society, and your participation is essential. Thank you.

How to fill out the questionnaires

Begin with this document, then fill out an individual form for each of the permanent residents of the dwelling.
To make the automatic reading of the questionnaires easier, please write with a black or blue pen. Do not use pencils or correction fluid.

To answer the questions:

- Check off the appropriate box: [x]
- Write one number in each grid space: [0][4]
- Write legibly [__________] [the words "Saint-Malo" are printed in the box in capital letters]

Do not cross out any boxes, even if the questions do not apply to you.

Do not fold the questionnaires.

Your answers are confidential

Your answers are confidential. They are intended for statistical processing, which include neither names nor addresses. This information is nonetheless necessary to verify that the dwellings and the people are counted one time only, and to ensure the quality of the statistical products.

[The following is in a box on the right of the page]

Box to be filled out by the enumerator

Identifier ___________

Municipality __________________________

Department _ _

Municipality _ _ _

Joint Trade Councils on Housing [CIL] code _ _ _

Statistical block group [IRIS] or district _ _ _

[FIL]
Rank A
Rank L

Dwelling category

[] 1 Principal residence
[] 2 Occasional dwelling
[] 3 Secondary residence
[] 4 Vacant dwelling

Type of building

Residential building with a single dwelling:
[] 1 Isolated
[] 2 Duplex, townhouse or grouped in any other manner
[] 3 Residential building with 2 dwellings or more
[] 4 Building for uses other than residential (community, factory, train station, stadium, office building, etc.)
[] 5 Temporary building, mobile home
[] 6 RV, mobile dwelling

Number of individual forms collected: _ _

BEGIN HERE

Dwelling localization

Number and street (or place name) ______________________________________

Supplementary address information _____________________________________

Municipality _______________________________________________________

Stair _________

Floor _ _

Position in relation to stair or number ___________

Name of principal occupant__________________________

Continue to pages 2, 3 and 4

[Legal language concerning the nature of the Census omitted]

[Page 1]

[Pages 2 and 3 make up a single form, which is the width of 2 pages placed side by side.]

PERMANENT RESIDENTS OF THE DWELLING

Write the name of every person who normally lives in this dwelling on list A, B or C. Don't forget to include yourself!

Then fill out an individual form for each person recorded on list A. Do not fill out a form for persons recorded on lists B or C.

Do not record people who are in the dwelling temporarily during the census and who normally live elsewhere (for example, people who are visiting or are on vacation).

LIST A: Permanent residents of the dwelling. Fill out one form for each individual

[The following is on the left of the form]

Record in list A:
- Persons who live in this dwelling most of the year, including:

- Persons who are temporarily absent (on vacation, business travel, in the hospital for less than one month, etc.)
- Newborns, even if they are still in the hospital
- Sub-tenants and co-tenants who occupy part of the dwelling

Also include in list A:

- Minor children who reside elsewhere for schooling, and for whom this residence is their family residence.
- Partners who have another place of residence for professional reasons and who return to live in this dwelling on weekends, vacation, etc.
- Adults who live in this dwelling for their schooling.
- Persons who are present in this dwelling and who do not have a permanent residence elsewhere.
- Domestic employees, staff and nannies who live in the dwelling.

[The following is written in 3 columns in the middle of the page. There are 8 rows for each column.]

- Last name (for example: Dupas, wife of Maurin)

- First name (for example: Francoise)

- Family ties or relationship with the person in line 1 (for examples: "Spouse")

If there are more than 8 persons, indicate how many additional persons _ _ and fill out an individual form for each one.

Do not write persons who should be listed in list B or list C.

List B: Adult children living elsewhere for their studies. Do not fill out individual forms

[The following is in a box on the right of the form]

Record in list B:
Adult children dwelling elsewhere for their schooling (a room in the city, independent dwelling, university residence hall, boarding school, etc.) who return to this dwelling for vacation or weekends, for example.

- Last name (for example: Lacombe)

- First name (for example: Olivier)

- Family ties or relationship with the person in line 1 of list A: (for example: son)

- Year of birth

- Address where this person lives for his studies

Number and street (or place name)
Municipality (or arrondissement for Paris, Lyon, or Marseille)
Department
Overseas department number

LIST C: Other residents of the dwelling. Do not fill out an individual form

[The following is written on the right side of the form, in 4 columns. Each column has 4 rows: two rows for C1 and two rows for C2]

Record on list C1:
Minor children who live in this dwelling for their schooling and whose parents reside in a different municipality in France.

Record on list C2:
- Children being cared for by a different parent (after a separation or divorce) or who, in case of joint custody, reside most of the time with the other parent
- Spouses who live in the dwelling for professional reasons and return on weekends to the family dwelling
- Persons for whom this dwelling is the principal residence and who are lodged in an institution (retirement home or hospice, hospitalization for more than one month, home for the disabled, workers' hostel, members of the military housed in a base or serving abroad, penal establishments, etc.)
- Persons who inhabit the dwelling at the time of the census but who reside most of the year in another dwelling.

C1:
- Last name ________________

- First name ________________

- Family relationship with the person in line 1 of list A (if line A is filled out) ________

- Year of birth _ _ _ _

C2:
- Last name ________________

- First name ________________

- Family relationship with the person in line 1 of list A (if line A is filled out) ________

- Year of birth _ _ _ _

Example

Mr. and Mrs. Maurin live in Saint-Malo. They have 3 children:
- Christophe is in the dwelling the entire year;
- Gregoire, 16, lives in a boarding school in Rennes;
- Julie, 21, is a student living in a rented room in Paris. She returns to her parents' home every weekend.

Mrs. Maurin has a 15-year old nephew, Thomas Galard, who lives with them and attends school in Saint-Malo. His parents live in Dax.

Mrs. Maurin's father, Jean Dupas, is staying with his daughter for four months; the rest of the year he lives in the Jura region.

List A: Permanent residents of the dwelling

MAURIN, Michel (-)
DUPAS, wife of MAURIN, Françoise (spouse)
MAURIN, Christophe (son)
MAURIN, Grégoire (son)

Four individual forms

List B: Adult children dwelling elsewhere for their schooling

MAURIN, Julie (daughter)
1985
3, Cauchy Street
Paris
15th [arrondissement]
75


No individual forms

List C: Other residents of the dwelling

C1: GALARD, Thomas (nephew) 1991
C2: DUPAS, Jean (father-in-law) 1929

No individual forms

[Pages 2 and 3]

Dwelling characteristics and comfort

[Questions 1-6 are in a column on the left of the page]

1. Type of dwelling

[] 1 House
[] 2 Apartment
[] 3 Retirement home
[] 4 Hotel room
[] 5 Makeshift housing
[] 6 Independent room (with its own entrance)

2. In what year was this house or building completed?

If different parts of the building are not from the same time period, write the year of completion of the largest inhabited part.

[] 1 Before 1949
[] 2 From 1949 to 1974
[] 3 From 1975 to 1981
[] 4 From 1982 to 1989
[] 5 From 1990 to 1998
[] 6 1999 or later
In this case, write the year _ _ _ _
[] 7 Inhabited building under construction

3. Does this dwelling have an elevator?

[] 1 Yes
[] 2 No

4. How many habitable rooms does this dwelling have?

Include habitable rooms such as the dining room, living room, bedrooms, etc., regardless of their size. Include the kitchen only if it is larger than 12 square meters. Do not include rooms such as the bathroom, laundry room, etc. Do not include rooms used exclusively for professional use (workshop, doctor's office, etc.).

_ _

5. How big is this dwelling?

Include all rooms, including hallways, kitchen, bathrooms, etc. Do not include balconies, porches, cellars, attics, parking areas, or rooms used exclusively for professional purposes.

[] 1 Fewer than 25 square meters
[] 2 From 25 to fewer than 40 square meters
[] 3 From 40 to fewer than 70 square meters
[] 4 From 70 to fewer than 100 square meters
[] 5 From 100 to fewer than 150 square meters
[] 6 150 square meters or more

6. Are you:

[] 1 The owner of this dwelling (including purchasing through special assisted loan programs [en accession], undivided co-ownership [en indivision], or through usufruct)?
[] 2 A tenant or sub-tenant of an unfurnished dwelling which you rent?
[] 3 A tenant or sub-tenant of a furnished dwelling or room which you rent?
[] 4 Housed for free with relatives, friends or your employer (including persons occupying a dwelling which they have a reverse mortgage [en viager])?

[Questions 7-13 are in a column on the left of the page]

7. Does this dwelling belong to a government-supported low-income housing agency?

[] 1 Yes
[] 2 No

8. In what year did you move into this dwelling?

If all current residents of the dwelling did not move in at the same time, indicate the move-in date of the first person to move in. If this person has always lived in the dwelling, indicate his/her year of birth.

_ _ _ _

9. What sanitary facilities are there in this dwelling?

[] 1 Neither bathtub nor shower
[] 2 Bathtub or shower in a room not used exclusively for bathing
[] 3 Bathroom (with shower or bathtub)

10. What is the principal method of heating the dwelling?

[] 1 Collective heat (a boiler shared by several dwellings in the building or an urban heating network)
[] 2 Individual boiler (unique to the dwelling)
[] 3 Individual "all electric" heat
[] 4 Wood stove, fireplace, stove, etc.

11. What is the principal fuel for heating?

[] 1 Urban heating
[] 2 City or network gas
[] 3 Fuel oil
[] 4 Electricity
[] 5 Bottled gas or gas from a tank
[] 6 Other

12. How many cars do the residents of the dwelling have available to them?

Don't count cars or vans that are exclusively for professional use.

[] 0 None
[] 1 One
[] 2 Two
[] 3 Three or more

13. Do you have a parking space for your personal use?

It may be a garage, a stall or a parking spot outside or underground.

[] 1 Yes
[] 2 No

[Don't forget to fill out an individual form for each person recorded on list A and sign it]

[Page 4]

2006 Population Census
Individual Form

[Boxes 1-5 are in a column on the left side of the page. Boxes 6-11 are in a column on the right.]

Last name: Lacombe
First name: Pierre
Address: 8, Saint-Antoine St., 69, Anse

1. Sex

[] 1 Male
[] 2 Female

2. Date and place of birth

Born on:

Day _ _
Month _ _
Year _ _ _ _

In: ___________________
(Municipality or administrative district for Paris, Lyon, or Marseille,)

Department _ _

Overseas department number ___

Country for foreigners; territory for overseas territories residents _____________

If you were born in another country, in which year did you arrive in France? Year _ _ _ _

3. What is your nationality?

French
[] 1 You were born in France
[] 2 You became French (for example, through naturalization, by declaration, upon becoming a legal adult).
Indicate your nationality at birth_________
[] 3 Foreigner. Indicate your nationality _____________

4. Are you enrolled in school in the current school year?

Include apprenticeships and university studies.

[] 1 Yes
[] 2 No
If yes, where is the school?
[] 1 In the same location of your current municipality of residence (or administrative district in Paris, Lyon, or Marseille)
[] 2 In a different location of your current municipality of residence (or administrative district in Paris, Lyon, or Marseille)
[] 3 In another municipality (or another administrative district in Paris, Lyon, or Marseille). Indicate the other municipality:
Municipality ______________
Department ____________
Overseas department number _________

5. Where were you living on January 1, 2001?

[Questions does not apply to children born after this date]

[] 1 In the same dwelling as now
[] 2 In another dwelling in the same municipality (or the same administrative district for Paris, Lyon, or Marseille)
[] 3 In another municipality (or another administrative district for Paris, Lyon or, Marseille). Indicate the other municipality:
Municipality ______________
Department ____________
Overseas department number _________
Country if abroad, territory if overseas territory _____________________

[Begin right-hand column]

Box to be filled out by enumerator

Municipality ______________________________
Department _ _
Municipality _ _ _

[Printed vertically along the side of the page is: "Form number 3"]

[6. The rest of the questionnaire is for persons age 14 or older.]

7. Are you living with a partner (living as a couple)?

[] 1 Yes
[] 2 No

8. What is your legal marital status?

[] 1 Single (never been legally married)
[] 2 Married (or separated, but not divorced)
[] 3 Widowed
[] 4 Divorced

9. What diplomas, certificates or degrees do you have?

[] 01 You have never been to school
[] 02 No diploma/certificate/degree but schooling up to primary school or high school
[] 03 No diploma/certificate/degree but schooling beyond high school
[] 11 Certificate of primary studies (CEP)
[] 12 General certificate of secondary education (BEPC); preliminary-level intermediate certificate (brevet elementaire); vocational school certificate (brevet des colleges)
[] 13 Vocational training certificate (CAP); journeyman's certificate [brevet de compagnon]
[] 14 Professional training certificate (BEP)
[] 15 General baccalaureate degree, certificate of advanced studies [brevet superieur]
[] 16 Technical or professional baccalaureate [baccalaureat technologique ou professionnel]; professional or technical vocational certificate [brevet professionnel ou de technicien]; basic legal qualification (2-year degree) [capacite en droit] ; certificate of agricultural education (BEA); certificate of business education (BEC); certificate of industrial education (BEI); BEM
[] 17 Preliminary-level university degree [diplome de 1er cycle universitaire]; advanced technical degree (BTS); technical degree from a university technology institute (DUT); degrees related to social or health-care professions, or nursing
[] 18 Advanced university degrees (including medical, pharmaceutical and dental); engineering degree, degree from a highly competitive public or private college, doctorate, etc.

10. What is your principal status?

Check off only one box.

[] 1 Employment (paid employee or working for self, including helping a person with his/her work). Check here and then go to Question 17.
[] 2 Contract apprenticeship or paid internship. Check here and then go to Question 17.
[] 3 Studies (student) or unpaid internship
[] 4 Unemployed (whether enrolled or not with the National Employment Agency)
[] 5 Retired or early retirement
[] 6 Housewife or househusband
[] 7 Other status

11. Are you currently working?

If you have occasional or very short-term employment, or if you are an apprentice or completing a paid internship, check "Yes". If you are on sick leave or maternity leave, check "Yes".

[] 1 Yes, check here and go to Question 17
[] 2 No, check here and go to Question 12

Go to the next page. Don't forget to sign.

[Page 5]

[Boxes 12-21 are in a column on the left. Boxes 22-30 are in a column on the right.]

[12. If you are not currently working answer questions 13-16]

13. Have you ever worked?

[] 1 Yes
[] 2 No, check here and then go to Question 16.

14. Were you

[] 1 A paid employee or a paid intern?
[] 2 Independent or working for yourself?
[] 3 Helping someone in his/her work without being paid?

15. What is your principal profession?__________

16. Are you looking for employment?

[] 1 Yes, have been looking for less than one year
[] 2 Yes, have been looking for a year or more
[] 3 No

[17. The rest of the questionnaire is for persons who are currently working. If you have several jobs, only describe your principal job in questions 18-30]

18. What is the name of the company which employs you or which you direct?

If you are a temporary employee, specify the name of the company where you work. If you work for yourself, write the name of the company or your name.

_____________________________

19. What does this company do?

Be very specific. (For example, "Automobile repair". If it is a farm, specify the type of production (grapes, poultry, etc.).

___________________________

20. What is the address of your place of work?

Indicate the place where you normally begin your job (for example, 18 Pasteur Boulevard). If it is not a stable location, write "Varies". If you work at home write "At home". If you work at an individual's house, write "Individual's house".

_________________

Is it in the municipality in which you reside (or the administrative district for Paris, Lyon, Marseille).
[] 1 Yes
[] 2 No
If not, indicate the municipality where you work_____________________________

21. What is the principal method of transportation you most often use to get to work?

[] 1 No transportation
[] 2 Walk
[] 3 Two-wheeled vehicle
[] 4 Car, truck or van
[] 5 Mass transit

22. Do you work

[] 1 Full-time
[] 2 Part-time

23. Are you/do you:

[] 1 An independent worker or self-employed?
[] 2 A paid business person, CEO, or minority shareholder manager of a limited liability company?
[] 3 A paid employee? If yes, go to Question 26
[] 4 Help someone in his/her job without pay?

24. If you work for yourself or in a business, how many paid employees do you employ?

[] 0 None
[] 1 1-9
[] 2 10 or more

25. If you are not a paid employee, what is your profession?

Be specific. For example, "Florist" rather than "Retailer"

___________________

[26. The rest of the questionnaire is for paid employees]

27. What is your contract or employment type?

[] 1 Non fixed-term employment; open-ended contract; civil service employees
[] 2 Apprenticeship contract
[] 3 Placed by a temporary-employment agency
[] 4 Paid internship with a company
[] 5 Youth employment contract [emploi-jeune]; solidarity employment contract (CES); qualification contract [contract de qualification] or other assisted employment
[] 6 Other fixed-term employment, fixed-term contract; short-term contract, seasonal, temp/casual

28. In your job, are you a/an:

[] 1 Unskilled worker, a semi-skilled worker
[] 2 Skilled or highly skilled worker, workshop technician [technician d'atelier]
[] 3 Technician/engineer (non-executive)
[] 4 Category B civil service employee
[] 5 Supervisor, commercial or administrative supervisor, salesperson
[] 6 Category A civil service employee
[] 7 Engineer, executive
[] 8 Category C or D civil service employee
[] 9 Employee (for example: in an office, salespeople/clerks, in a restaurant or house)

29. What is your principal profession?

Be specific. For example: "Cashier" and not "Employee", "Head of client services" and not "Executive". If you are a state, territorial or hospital civil service employee, indicate your rank (unit, category, etc.)

_______________

30. What is your principal role at your job?

[] 1 Production, operations, work site
[] 2 Installation, repair, maintenance
[] 3 Management, accounting
[] 4 Reports, research
[] 5 Other: commercial, secretarial, logistical, etc.

Date___________________

Signature______________________

[Legal language concerning the obligatory nature of the Census is omitted here]