[pg. 1]
Stage A Questionnaire (MP/2)
[Questions 1-31]
Data given in this questionnaire will serve for statistical purposes only, except the items: name, address and identity number, which are required by the registration clerks, according to the law of Population Registration- 1965. The answer to the question about a shelter is not required according to the Statistics Ordinance 1947 and will be reported to the civil defense authorities.
For office use
[Personal data below and questions 1-5 were generally preprinted]
____ Surname
____ First name
____ Address
____ Year of birth
1. No. of enumeration district _ _ _ _ _ _ _
2. Identity No. _ _ _ _ _ _ _
3. Auxiliary No. _ _ _ _
4. Number of household in enumeration district _ _ _
5. Number of person _ _
6. Relation to household head
[] 2. Spouse of household head
[] 3. Son/daughter
[] 4. Son/daughter in law
[] 5. Grandson/daughter
[] 6. Parent of household head
[] 7. Parent of the spouse
[] 8. Other relation
[] 9. No relative
7. Year of birth _ _ _ _
8. Month of birth _ _
10. Marital status
[] 2. Divorced
[] 3. Widowed
[] 4. Single
11. Is he/she
[] 2. Moslem
[] 3. Greek-Catholic
[] 4. Greek-Orthodox
[] 5. Latin (Catholic)
[] 6. Druze
[] Other Christian ____
[] Other ____
12. Place of birth
[] 2. Abroad
13. [Country of origin]
For born abroad, [specify] country of birth.
[] 01. Israel
[] 02. Iran (Persia)
[] 03. Bulgaria
[] 04. U.S.S.R
[] 05. Germany
[] 06. Hungary
[] 07. Tunisia
[] 08. Turkey
[] 09. Libya
[] 10. Egypt
[] 11. Morocco
[] 12. Iraq
[] 13. Poland
[] 14. Rumania
[] 15. Yemen
[] Other county ____
14. Year of immigration: 19 _ _
15. Has he another address besides the stated one (for study, work, therapy, etc.)
[] 2. Yes; mark address ________
16. Did he stay at the additional address at least 4 nights a week during the last month?
[] 2. No
17. Does the spouse live at the additional address?
[] 1. Yes
[] 2. No
18. Does not live in the enumeration district; mark cause.
[] 1. Deceased
[] 2. Emigrated
[] 3. Abroad more than 1 year
[] 4. Live outside enumeration district; give address ____
[] 5. Other cause ____
[] 6. Mark and fill out another questionnaire.
Fill out for household head only
[Questions 20-27 were asked of household heads]
21. Number of house _ _ _
22. Sub-number _
23. Apartment number _ _
24. Number of rooms in apartment _
25. Type of apartment
[] 2. Unusual
26. Total persons in household _ _
[] 2. Apartment whose dwellers are not enumerable
Fill out for first household head at this address
[Questions 28-31 were asked of first household heads in cases when there was more then one household in the same dwelling.]
28. Year of finishing construction: 19 _ _
30. [Bomb] Shelter
[] 2. No
[] 2. Concrete blocks, concrete, mortar
[] 3. Tin, earth, wood, asbestos
[pg. 2]
Family Questionnaire Stage B (MP/11)
Dear Resident:
Please fill in answers in the following manner:
Make a circle around the number or corresponding sign to the right of the questions. If there is a square, write down your answer within it. If there is a dotted line, record your answer on the appropriate line. In some questions, there is a note. This note refers only to the question preceding it and not to other questions.
Look at the "Sample Questionnaire" and the explanations, before filling out this questionnaire.
This questionnaire should be filled out with pencil only.
Question on family apartment
[Questions 1-20]
1. In how many rooms does your family live? ____
2. What is the principal arrangement for heating the apartment in the winter?
[] 2. Other fixed installation- kerosene stove, gas, fuel oil, heat storage
[] 3. Movable stove (electric, gas, kerosene)
[] 4. No arrangement for heating apartment
3. Is there a kitchen? (not including a cooking corner)
[] 2. No kitchen
4. Is there a bath or a shower and is it solely for your use?
[] 2. Bath, used jointly with others
[] 3. Only shower, solely for the use of the family
[] 4. Only shower, used jointly with others
[] 5. No bath and no shower
5. What is the principal arrangement for heating of water in the bath, or shower?
[] 2. Solar heater
[] 3. Electric or gas boiler
[] 4. Kerosene, wood, coal, etc.
[] 5. No arrangement for heating water
[] 6. No bath and no shower
6. Do you have a lavatory?
[] 2. There are 2 lavatories. Mark and pass on to question 9.
[] 3. There is 1 toilet
[Questions 7-8 were asked of those with 1 toilet, per question 6.]
7. Where is the lavatory located?
[] 2. Outside the building
8. Is the lavatory located together with the bath or shower?
[] 2. The lavatory is located separately
9. Is there a telephone in the apartment?
[] 2. No
10. Do you have a television set?
[] 2. No
11. Do you have a washing machine?
[] 2. No
12. Do you have a baking range operated by gas or electricity?
[] 2. No
13. Do you have an air conditioner in the apartment? (Do not include fan.)
[] 2. No
14. Do you have a car?
[] 1. Car in possession of family
[] 2. Car for use of family, but not in its possession
[] 3. No car
15. In what year did the first member out of those now living in the apartment move in?
[] If not from birth, note year of entry: 19_ _
16. Is the apartment in your possession, or is it rented?
[] 2. Rented. Mark and pass on to question 18.
[] 3. Not in possession and not rented. Pass on to next page. [Skip questions 17-20.]
17. At how much do you estimate the value of the apartment? ____
Pass on to next page. [Skip questions 18-20.]
[Questions 18 to 20 were asked only of persons in rented apartments.]
18. What is the monthly rent? ____
19. Will you be getting key money (or pay on vacating) should you vacate the apartment?
[] 2. Entitlement to key money or pay on vacating (for those living in "Amidar" apartments)
[] 3. Entitled to key money (for those not living in "Amidar" apartments)
20. At how much do you estimate the value of the key money (including the third for the owner of the apartment)? ____
Enumerator: Record the total of members of the family born in 1958 or before: ____
[pg. 3]
Enumerator: Record here data only for those born in 1958 or before:
_ _ Number of person in Stage A questionnaire
_ _ Year of birth
____ Sex
The questions in this page and the next page refer solely to the person whose name appears above.
[Questions 1-24 asked only of those 14 years of age or older.]
1. From what year have you lived in this settlement?
[] If not from birth, mark year of move to this locality: 19_ _
2. Where was your permanent place of residence in May 1967, in other words, before the Six-Day War?
[] At another address
[] Abroad
[] In Israel; note address ____
3. Did you marry and when?
[] Married once -- Mark year of marriage: 19_ _
[] Married more than once -- Mark years of marriages:
Last: 19_ _
Unmarried men and women will pass to question 6. Question 4 and 5 are intended for every married, divorced, or widowed woman.
[Questions 4-5 were asked of married, divorced or widowed women aged 14+]
4. To how many children did you give birth?
[] No children born. Mark and pass to question 6 [skip question 5]
[] Number of children born (Mark 1, 2, 3 and so on) ____
5. How many children of those recorded were born abroad?
[] Number of children born (Mark 1, 2, 3 and so on) ____
Your education
[Questions 6-12]
Considered as schools: studies in evening school, Yeshiva, university, academy of music, etc. Will not be considered schools: courses of under one year, correspondence courses, language courses etc.
6. Do you study or have you studied at a school before?
[] Studies in a school in the past and does not study at present. Mark and pass to question 8.
[] Studies at present at school. Mark name and type of school and its address.
____ Address of school: Settlement Street/Quarter Number of house
7. What is the principal means of transportation for going to school?
[] 1. Special bus for conveying pupils
[] 2. Public bus
[] 3. Bicycle
[] 4. Motorcycle, scooter, or bicycle with auxiliary motor
[] 5. Private or commercial vehicle
[] 6. Taxi, including mini-bus
[] 7. Train, or carmelit
[] 8. Other vehicle
[] 9. Walking
[Questions 8-10 were asked of persons aged 14+ who presently study at a school or studied in past, per question 6]
8. How many years altogether did you study at school? ____
9. What is the type of the school you attended last, or where you are studying at present?
[] 2. Intermediate classes (between primary and secondary schools)
[] 3. Yeshiva, "Madrassa Diniyyah"
[] 4. Vocational, agricultural secondary school
[] 5. Secondary school
[] 6. Teachers training college (post primary)
[] 7. Other post-secondary school, such as school for qualified nurses, surveyors' school
[] 8. University, technion
[] 9. Other school, mark _________
10. What is the highest certificate (degree) that you received?
[] 2. Certificate and completion of post-secondary school
[] 3. Matriculation or other certificate [illegible]
[] 4. Other certificate of completing secondary studies
[] 5. None of those certificates
11 Can you write (at least a simple letter)
[] No
[] No
[] No
12. What is the language, or languages, that you speak in everyday life?
____ Mark single or principal language
____ Mark second language
____ Mark third language
In questions 13-21, full or part-time work for payment, profit, or other remuneration, and also work of a family member without pay in a family business will be considered as "work". Not considered as "work": work of woman in her own household.
13. Did you work during the last week at least one hour?
[] 2. Worked
[] 3. Did not work.
[Questions 14-16 were asked of persons aged 14+ who did not serve in regular or professional military service (not including army reserves) last week, per question 13]
14. Did you actively look for work during the last week?
[] 1. Yes
[] 2. No
15. Do you have a job, a business, or an agricultural farm that you were absent from in the last week (for reasons of leave, sickness, army reserve duty, or other cause)?
[] 2. No
16. For how many weeks did you work in Israel in all places of work during the last 12 months?
[] 00. Did not work for a single day. Mark and pass to question 24.[skip questions 17-23]
[] If worked less than one year, indicate for how many weeks worked: ____
[] 99. Worked the whole year
[Questions 17-21 were asked of persons age 14+ who worked and did not serve in regular or professional military service last week, per questions 13, 16]
17. During the weeks that you worked, how many hours weekly did you work in general (including hours that you worked in all places of work)? Mark number of hours. ____
Your place of work
[Questions 18-21]
If you worked last week, please mark details of your main work. If you did not work last week, but worked in Israel during the last 12 months, give details of your last work.
18. Where did you work?
b. Description of principal activity of the place of work ____
c. Branch or division (if existing) in which you work ____
d. Address of your place of work
____ Settlement
____ Street/Quarter
____ Number of house (or identifiable adjacent place)
19. What is the principal means of transportation by which you reach the above place of work?
[] 2. Private or commercial vehicle
[] 3. Taxi, including mini-bus
[] 4. Motorcycle, scooter, or bicycle with auxiliary motor.
[] 5. Bicycle
[] 6. Truck
[] 7. Train, or carmelit
[] 8. Other vehicle
[] 9. Not traveling
20. What is the principal work at your place of work?
21. What is your position at the place of work?
[] 2. Self-employed, not employing hired personnel
[] 3. Self-employed, employing 1-2
[] 4. Self-employed, employing 3 and more
[] 5. Member of a cooperative
[] 6. Member of qibbuz (not employee)
[] 7. member of family working without pay in family business or farm
Income
[Questions 22-24]
[illegible]; if no income in a given section - mark "0".
[Questions 22-23 were asked of persons aged 14+ who worked or served in regular or professional military service (not including army reserves) last week, per question 13]
22. What was your gross income (before deductions) from wages and salary in all places of work?
A. Last month ____
B. In the last 12 months ____
C. Is the last amount noted gross?
[] 2. No
23. What was your gross income in 1970/71 from your work as self-employed? ____
24. What were your and your family's income not from work during the last 12 months? ____
Record: regular income. Do not record: one-time income, such as: inheritance, severance pay, lottery win, etc.
A. Pensions, locally and from abroad. ____
B. Assistance, or allowances such as: national insurance, ministry of defense, Malben. ____
C. Assistance by relatives who do not live with you. ____
D. Gross income, from letting apartment, leasing property, interest, dividends, and non-active partnership in a business. ____
E. Other current income, not marked above. ____