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Population survey 2014

Space to be filled out by the survey agent

Identifier
Municipality ____
Department _ _
Municipality _ _ _
District _ _ _ _
Line A _ _ _
Line L _ _ _

Dwelling category

[ ] 1 Primary residence
[ ] 2 Occasional residence
[ ] 3 Secondary residence
[ ] 4 Dwelling vacant

Type of construction

Residential building with one dwelling
[ ] 1 Isolated
[ ] 2 Paired or grouped together in any way
[ ] 3 Residential building of two or more dwellings
[ ] 4 Non-residential building (community, factory, station, stadium, office building, etc.)
[ ] 5 Temporary construction, mobile home
[ ] 6 Trailer, mobile home

[Housing sheet (DOM-Overseas Departments]

Type of construction

[ ] 1 Makeshift dwelling
[ ] 2 Traditional hut
[ ] 3 Wood house or building
[ ] 4 Hard-material house or building

Number of individual forms collected _ _

Start here

Name of primary occupant ________

Location of dwelling
Address 1 _ _ _ _
Address 2 ____
Street ____
Name of road ________
Residence, hamlet, building ________
Stairs ____
Floor ____
Door number or position from stairs:

Hallway to the right, 1st door on the left

Postal code _ _ _ _ _
Municipality (and district for Paris, Lyon and Marseille)

Continue to pages 2, 3, and 4

Individuals usually living in the dwelling

Record either in list A or in list B or in list C each person who usually lives in this dwelling.
Do not forget to record yourself!

Then, fill out the individual form for each person recorded or listed in list A. Do not fill out any individual forms for persons listed in list B or in list C.

Do not record the temporary dwellers who usually live elsewhere but who are here during the census (for example, people visiting or on vacation).

List A-Permanent residents of the dwelling
Fill out an individual form for each one

Record in list A:

Persons who live in this dwelling for the majority of the year, including:
Individuals who are temporarily absent (vacation, business travel, hospitalization of less than one month, etc.);

Infants, even if they are still in the maternity ward

Subtenants and joint tenants occupying part of the dwelling
Also record in list A:
Minors living elsewhere for their studies and for whom this dwelling is their family residence

Spouses who have another place of residence for professional reasons and who come to live in this dwelling on weekends, vacations, etc.

Adults who live in this dwelling because of their studies

Persons who are present in this dwelling and who do not have a usual residence elsewhere.

Household employees or au pairs who live in this dwelling.

Do not record the individuals who are to be listed in list B or in list C

Last name (example, Dupas, nee Maurin)
First name
Relationship to the person recorded on the first line (examples: spouse, domestic partnership, son, daughter, mother, father, sub-tenant, etc.)

If there are more than 8 people, record the number of extra people ___ and fill out an individual form for each one.

List B-adult children living elsewhere for their studies
Do not fill out an individual form

Record in list B:

Adult children living elsewhere for their studies (room in town, independent dwelling, university dormitory, boarding school, etc.) and who come back to live in this dwelling for vacations or weekends, for example.

Last name
First name
Relationship to the person recorded on the first line
Year of birth
Address where this person lives for school

Address
Municipality (and district for Paris, Lyon, Marseille)
Department
Overseas department number

List C- Other residents in the dwelling
Do not fill out an individual form

Record in list C1:

Minors living in this dwelling for their studies whose parents live in another municipality in France.
Record in list C2:
Children in the custody of another parent (after a separation or a divorce) and who, in the case of joint custody, live mostly with the other parent.

Individuals who live in this dwelling for professional reasons and who return to their family residence on the weekend.

Individuals for whom this dwelling is their personal residence and who are housed in a retirement home or hospice, hospitalized for more than one month, center for handicapped people, boarding house for workers, military personnel housed in barracks or serving abroad, penitentiaries, etc.)

Persons living in this dwelling at the time of the survey but who live in another dwelling for the majority of the year.

Last name
First name
Relationship to the person recorded on the first line of list A (if this line is filled out)
Year of birth

Example:
Mr. and Mrs. Maurin live in Saint-Malo. They have three children:

Christophe is present in this dwelling year-round;

Gregoire, age 16, is a boarder at a high school in Rennes;

Julie, age 21, is a student in Paris. She rents a room and returns to her parents during vacations.

Mrs. Maurin loges her 15 year old nephew, Thomas Galard, who is a student in Saint-Malo. His parents live in Dax.

Jean Dupas, Mrs. Maurin’s father, is staying with his daughter for four months. He lives in Jura the rest of the year.

List A: Permanent residents of the dwelling

Maurin, Michel
Dupas, nee Maurin, Francoise, spouse
Maurin, Christophe, son
Maurin, Gregoire, son
List B: adult children living elsewhere for their studies
Maurin, Julie, daughter, 1993,
3, Cauchy Street, Paris 15th, 75
List C: Other residents in the dwelling
C1: Galard, Thomas, nephew, 1999
C2: Dupas, Jean, Father-in-law, 1937

Characteristics and comforts of the dwelling

1) Type of dwelling:

[ ] 1 House
[ ] 2 Apartment
[ ] 3 Communal dwelling
[ ] 4 Guestroom
[ ] 5 Makeshift shelter
[ ] 6 Separate room (having a separate entrance)

2) What is the year of completion on the construction of this house or apartment building?
(If different sections are not from the same time period, note the completion year of the most lived-in section)

[ ] 1 Before 1919
[ ] 2 From 1919 to 1945
[ ] 3 From 1946 to 1970
[ ] 4 From 1971 to 1990
[ ] 5 From 1991 to 2005
[ ] 6 2006 or later—if this is the answer, specify the year _ _ _ _

3) Does this dwelling have an elevator?

[ ] 1 Yes
[ ] 2 No

4) How many livable rooms are in this dwelling?

Count livable rooms like dining rooms, living rooms, family rooms, bedrooms, etc., regardless of their size.

Only count the kitchen if it is bigger than 12m2

Do not count rooms like bathrooms, laundry or utility rooms, WCs, etc., or rooms with exclusively professional uses (workshops, doctor’s offices, etc.)

5) What is the size of the dwelling?
Count all rooms, including the hallway, kitchen, bathroom, WC, etc.

Do not count balconies, patios, cellars, attics, garages, and rooms with exclusively professional uses.

[ ] 1 Less than 30m2
[ ] 2 From 30 to less than 40m2
[ ] 3 From 40 to less than 60m2
[ ] 4 From 60 to less than 80m2
[ ] 5 From 80 to less than 100m2
[ ] 6 From 100 to less than 120m2
[ ] 7 120m2 or more

6) Are you:

[ ] 1 The owner of this dwelling (including if you are currently purchasing it, have joint ownership, or if you have rights by usufruct)?
[ ] 2 A renter or subtenant of dwelling, unfurnished?
[ ] 3 A renter or subtenant of the dwelling or room, furnished?
[ ] 4 Living for free, for example from parents, friends, or employer (including persons living in a dwelling that that they sold for life annuity)?

7) Does this dwelling belong to a housing project association?

[ ] 1 Yes
[ ] 2 No

8) In what year did you move to this dwelling?
If all the current occupants of the dwelling did not arrive at the same time, give the arrival date of the first who lived here. If that person has always lived in the house, record his or her year of birth. _ _ _ _

9) What are the sanitation facilities for this dwelling?

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

10) What is the main method of heating for this dwelling?

[ ] 1 Community heating (common boiler for several dwellings in the building or network of city heating)
[ ] 2 Individual boiler (particular to the dwelling)
[ ] 3 Individual boiler "all electric"
[ ] 4 Wood-burner, fireplace, stove, etc.

11) What is the primary heating fuel?

[ ] 1 City heating
[ ] 2 Gas from town or grid
[ ] 3 Heating oil (fuel oil)
[ ] 4 Electricity
[ ] 5 Bottle gas or gas in tanker
[ ] 6 Other (wood, solar, geothermic etc.)

12) How many cars do the residents of this dwelling have at their disposal?
Do not count cars or vans that are for professional use only.

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

13) Do you have a parking space reserved for your personal use?
This location can be a garage, a lock-up in a garage, or a parking space outside or underground.

[ ] 1 Yes
[ ] 2 No

[Housing sheet (DOM-Overseas Departments]

9) Is there a watering place with potable water inside this apartment?

[] Cold water only
[] Cold and hot water
[] No watering place

10) The sewage is disposed of by connecting:

[ ] 1 To a sewer system?
[ ] 2 To a septic tank?
[ ] 3 To a sump?
[ ] 4 Into the ground?

11) Does this dwelling have:
Check yes or no for each line

Electricity?

[ ] 1 Yes
[ ] 2 No

An indoor WC?

[ ] 1 Yes
[ ] 2 No

A bathtub or shower?

[ ] 1 Yes
[ ] 2 No

An indoor kitchen with a sink?
[ ] 1 Yes
[ ] 2 No

At least one air conditioned room?
[ ] 1 Yes
[ ] 2 No

A solar water heater?
[ ] 1 Yes
[ ] 2 No

A heating system?
[ ] 1 Yes
[ ] 2 No

12) How many two-wheeled motor vehicles do inhabitants of this dwelling have?
Do not count those for professional use only.

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

13) How many cars do the residents of this dwelling have at their disposal?
Do not count cars or vans that are for professional use only.

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

14) Do you have a parking space reserved for your personal use?
This location can be a garage, a lock-up in a garage, or a parking space outside or underground.

[ ] 1 Yes
[ ] 2 No


Population survey 2014

Individual form

Last name:

(example: Dupas, nee Maurin)
First name:
Address:

Space to be filled out by survey agent

Municipality ________
Department _ _
Municipality _ _ _

1) Sex

[ ] 1 Male
[ ] 2 Female

2) Date and location of birth
Born on _ _ (day) _ _ (month) _ _ _ _ (year)
At ____ Municipality (district for Paris, Lyon, Marseille)

Department _ _
DOM (overseas department) number _
Country for those abroad, territory for DOM (overseas territory) ____

If you were born abroad, in what year did you arrive in France?

Year _ _ _ _

3) What is your nationality?

French
[ ] 1 You were born French
[ ] 2 You became French (for example, through naturalization, through declaration, at adulthood)
Indicate your nationality at birth ____
Foreigner
Indicate your nationality ____

4) Are you enrolled in a learning establishment for the current school year?
Including an apprenticeship or higher education

[ ] 1 Yes
If yes, where is this learning establishment located?
[ ] 1 In the municipality where you live (or in the same district for Paris, Lyon, Marseille)
[ ] 2 In another municipality (or another district)
Indicate this other municipality ____
Municipality (and district for Paris, Lyon, Marseille), department, DOM (overseas department) number
[ ] 2 No

5) Where were you living on January 1, 2013? [one year ago]
Children born after this date do not apply.

[ ] 1 In the same dwelling as now
[ ] 2 In another dwelling in the same municipality (or in the same district for Paris, Lyon, Marseille)
[ ] 3 In another municipality (or another district for Paris, Lyon, Marseille)
Indicate this other municipality ____
Municipality (and district for Paris, Lyon, Marseille), department, DOM (overseas department) number, country for aboard, territory for TOM (overseas territories)

6) The following portion of the questionnaire is for individuals age 14 or older.

7) Do you live with a partner?

[ ] 1 Yes
[ ] 2 No

8) What is your legal marital status?

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

9) What diplomas do you have?

[ ] 01 You never went to school
[ ] 02 No diploma, but educated until primary or middle school
[ ] 03 No diploma but educated past middle school
[ ] 11 CEP (Primary education certificate)
[ ] 12 BEPC, France, general certificate of secondary education
[ ] 13 CAP, vocational training qualification
[ ] 14 BEP [##translator note: school-leaving diploma, taken at about 18]
[ ] 15 General baccalaureate [##translator note: high school diploma]
[ ] 16 Technical or professional baccalaureate, Professional or technical certificate, BEA, BEC, BEI, BEH, basic legal qualification
[ ] 17 1st cycle university diploma, BTS, DUT, social or health professions diploma, nursing
[ ] 18 2nd or 3rd cycle university diploma (including medical, pharmacy, dental), engineering diploma, grande école [##translator note: extremely selective private schools], doctorate, etc.

10) What is your primary occupation?
Only tick one space

[ ] 1 Job (employee or self-employed, including helping someone in his/her work)
Tick then skip to 17
[ ] 2 Apprenticeship under contract or paid internship
Tick then skip to 17
[ ] 3 Studies (pupil, student) or unpaid internship
[ ] 4 Unemployed (whether registered or not at the unemployment center)
[ ] 5 Retired or pre-retired (formerly employed or formerly independent)
[ ] 6 Homemaker
[ ] 7 Other circumstances

11) Are you currently working?
If you have a job where you work from time to time, or if you are temporarily employed, or if you are in an apprenticeship or a paid internship, tick "yes".
If you are on medical or maternity leave, tick "yes".

[ ] 1 Yes, tick then skip to 17
[ ] 2 No, tick then skip to 12

Continue to next page, and don't forget to sign

12) If you are not currently working, answer questions 13-16.

13) Have you ever worked?

[ ] 1 Yes
[ ] 2 No, tick then skip to question 16

14) Were you:

[ ] 1 Salaried or a paid intern?
[ ] 2 Independent or self-employed?
[ ] 3 Helping a person in his or her work without getting paid?

15) What was your main profession?

16) Are you looking for a job?

[ ] 1 Yes, for less than a year
[ ] 2 Yes, for a year or more
[ ] 3 No

17) The rest of the questionnaire is for individuals who are currently working.
If you have several jobs, describe your main job in questions 18 to 30.

18) What is the name of the establishment which employs you or of which you are in charge?
If you are a temporary worker, specify the name of the establishment where you work. If you are self-employed, record the name of the company or your name.

19) In what business sector is this establishment?
Be very specific (for example: "auto repair"). If it is a farm, specify the type of products (vineyard, poultry farming, etc.).

20) What is the address of your place of work?
Record the place where you usually start your work (example, 18 Pasteur Boulevard).
If this place is not fixed, record "variable".
If you work from home, record "from home".
If you work at a private individual’s, record "private".

________ Is this in the municipality where you live? (or district for Paris, Lyon, Marseille)
[ ] 1 Yes
[ ] 2 No

If no, record the municipality where you work
Municipality (or district if Paris, Lyon, Marseille) ________
Department _ _
DOM (overseas department) number _
Country for aboard ____

21) What is the method of transportation you usually use to go to work?

[ ] 1 No transportation
[ ] 2 On foot
[ ] 3 Two-wheeled vehicle
[ ] 4 Car, truck, or small van
[ ] 5 Public transportation

22) Do you work:

[ ] 1 Full time
[ ] 2 Part time

23) Are you:

[ ] 1 Independent or self-employed?
[ ] 2 Salaried company head, CEO, manager, minority of a limited liability company?
[ ] 3 Salaried, tick then skip to 26
[ ] 4 You help an individual in his/her work without pay

24) If you are self-employed or if you are a company head, how many employees do you employ?

[ ] 1 None
[ ] 2 1 to 9
[ ] 3 10 or more

25) If you are not salaried, what is your profession?
Be specific. For example "florist" (and not "shopkeeper")

26) The next part of this questionnaire is for salaried employees.

27) What is your type of contract or employment?

[ ] 1 Employment without limit in length, CDI (contract of indeterminate length), tenured as a public employee
[ ] 2 Apprenticeship and professionalism contract
[ ] 3 Placed by a temp agency
[ ] 4 Paid internship in a business
[ ] 5 Helped employment (single inclusion contract, employment initiative, support for employment, the future, etc.)
[ ] 6 Other limited length employment, CDD (fixed-length contract), short contract, seasonal, replacement worker

28) In your work, are you:

[ ] 1 A skilled or unskilled laborer?
[ ] 2 A skilled or highly skilled laborer, a skilled workshop specialist?
[ ] 3 A technician (non-executive)?
[ ] 4 A category B public official?
[ ] 5 A middle management official, administrative or commercial official, a sales representative?
[ ] 6 A category A public official?
[ ] 7 An engineer, business executive?
[ ] 8 A category C or D public official?
[ ] 9 An employee (for example, in an office, in commerce, in the restaurant industry, in a home)?

29) What is your main profession?
Be precise. For example: "Cashier" (not "employee"),
"Head of client services" (not "manager").
If you are a public State official, of regional authority or for hospitality [##translator note: there is a chance that the original term "hospitalière," refers to a hospital worker. However, given the context, I believe it is related to hospitality], record your level (professional, category, etc.)

30) What is your main duty in your work?

[ ] 1 Production, farming, construction
[ ] 2 Installations, repairs, maintenance
[ ] 3 Management, accounting
[ ] 4 Learning, research
[ ] 5 Other: sales, secretarial, logistics

Thank you for your participation