Questionnaire Text

Questionnaire form view entire document: text image

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

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.

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 ____