Please complete this form and have it ready for collection on Monday
22nd April.
Completion of the form is compulsory under the Census Act 1920.
If you refuse to complete it, or give false information, you may
have topay a fine of up to £400.
Your answers will be treated in strict confidence and used only
to produce statistics. Names and addresses will not be put into
the computer; only the postcode will be entered. The forms will
be keptsecurely within my Office and treated as confidential for
100 years.
Anyone using or disclosing Census information improperly will beliable
to prosecution.
After completing the form, please sign the declaration on the last
page.
Thank you for your co-operation.
P J Wormald
Registrar General
Office of Population Censuses and Surveys
PO Box 100
Fareham PO 16 OAL
Telephone: 0329 844444
To be completed by the
Enumerator
Census District
Enumeration District
Form number
Serial number
To be completed by the
Manager, Commanding Officer, Chief Resident Officer, or other person
in charge of the establishment or vessel.
Name of Establishment
Address
Postcode
To be completed by or for the
individual
Please answer question by ticking
the appropriate box or boxes
where they are provided. Please use ink or ballpoint pen.
1
Name
Please write in your name and surname (BLOCK CAPITALS).
For a baby who has not yet been given a name, write BABY and the surname.
2
Sex
Please tick the appropriate box.
Male1
Female2
3
Date of birth
Please write in the day, month and year of birth.
Day
Month
Year
4
Marital status
On the 21st of April what is your marital status?
If separated but not divorced, please tick 'Married (first marriage)'
or 'Re-married' as appropriate.
Please tick one box.
Single
(never married)1
Married (first marriage)2
Re-married3
Divorced (decree absolute)4 Widowed5
5
Position
in establishment
Please write in your position in this establishment.
For example, write 'Guest'; 'Patient'; 'Inmate'; 'Staff'; 'Student';
'Boarder'.
If you are completing the form in a private household, your relationship
to the person making the return for
the rest of the household should be stated.
6
Whereabouts
on night of 21-22 April 1991
Not applicable to
this form
7
Usual address
If you usually live here, please tick 'This address'. If not, tick
'Elsewhere' and write in your usual address.
If you are a student or a schoolchild away from home during term
time, your home address should be taken as your usual address.
If you live away from home for part of the week, your home address
should be taken as your usual address.
This address1
Elsewhere
If elsewhere, please write your usual address
and postcode below in BLOCK CAPITALS
Postcode
8 Term
time address of students and schoolchildren
Not a student or schoolchild
This address
1
Elsewhere
If elsewhere, please write the
person's usual address and postcode below in BLOCK CAPITALS
Postcode
.
.
.
.
.
.
.
.
If not a student or schoolchild, please
tick first box.
If you are a student or schoolchild
and you live here during term time, tick 'This address'.
If you do not live here during term
time, tick 'Elsewhere' and write in the current or most recent term time
address.
9 Usual
address one year ago
Same as question 7
1
Different
Child under one
3
If different, please write the
person's address and postcode on the 21st April below in BLOCK CAPITALS
Postcode
.
.
.
.
.
.
.
.
If your usual address one year ago
(on the 21st April 1990) was the same as your current usual address (given
in answer to question 7), please tick 'Same'. If not, tick 'Different'
and write in the usual address one year ago.
For a child born since the 21st April
1990, tick the 'Child under one' box.
10
Country of birth
England
1
Scotland
2
Wales
3
Northern Ireland
4
Irish Republic
5
Elsewhere
If elsewhere, please write in
the present name of the country
Please tick the appropriate box.
If the 'Elsewhere' box is ticked, please
write in the present name of the country in which the birthplace is now
situated.
11 Ethnic group
White
0
Black-Caribbean
1
Black-African
2
Black-Other please describe
Indian
3
Pakistani
4
Bangladeshi
5
Chinese
6
Any other ethnic group please describe
Please tick the appropriate box.
If you are descended from more than
one ethnic or racial group, please tick the group to which you considers
you belong, or tick the 'Any other ethnic group' box and describe your
ancestry in the space provided.
12 Long-term
illness
Yes, I have a health problem
which limits activities
1
I have no such health problem
2
Do you have any long-term illness,
health problem or handicap which limits your daily activities or the work
you can do?
Include problems
which are due to old age.
Answers to the remaining questions
are not required for anyone under 16 years of age (born after 21st April
1975)
13 Whether
working, retired, looking after the home etc last week
Which of these were you doing last
week?
Please read carfully
right through the list and tick
all the descriptions that apply.
* Casual or temporary work
should be counted at boxes 1,2,3 or 4. also tick boxes 1, 2, 3
or 4 if you had a job last week but were off sick, on holiday,
temporarily laid off or on strike.
Boxes 1, 2, 3 and 4 refer
to work for pay or profit but not to unpaid work except in a family
business.
Working for an employer is
part
time
(box 2) if the hours worked, excluding any overtime and mealbreaks,
are usually 30 hours or less per week.
† Includes wanting a
job but prevented from looking by holiday or temporary sickness.
$ Do not count training given
or paid for by an employer.
* Was working for an employer
full time (more than 30 hours per week)
1
* Was working for an employer
part time (one hour or more a week)
2
* Was self-employed, employing
other people
3
* Was self-employed, not employing
other people
4
Was on a government employment
or training scheme
5
Was waiting to start a job he/she
had already accepted
6
† Was unemployed and looking
for a job
7
$ Was at school or in other
full time education
8
Was unable to work because of
long term sickness or disability
9
Was retired from paid work
10
Was looking after the home or
family
11
Other Please specify
Please read A below, tick the
box that applies and follow the instruction by the box ticked.
This will tell you which questions to answer.
A
Did you have a paid job last
week (any of the boxes 1, 2, 3 or 4 ticked at question 13)?
Yes
No
If yes ticked, answer questions 14,
15, 16, 17 and 18 about the main job last week, then go on to
question 19. If no ticked, answer B.
B
Have you had a paid job within
the last 10 years?
Yes
No
If yes ticked, answer questions 14,
15, and 16 about the most recent job, then go on to question
19. If no ticked, go on to question 19.
14
Hours worked per week
How many hours per week do or did
you usually work in your main job?
Do not count overtime or meal
breaks.
Number of hours worked per week
15
Occupation
Please give the full title of your
present or last job and describe the main things you do or did in the
job.
At a, give
the full title by which the job is known, for example: 'packing machinist';
'poultry processor'; 'jig and tool fitter'' 'supervisor of typists'; 'accounts
clerk'' rather than general titles like 'machinist'; 'process worker';
'supervisor' or 'clerk'. Give rank or grade if you have one.
At b, write
down the main things you actually do or did in the job.
Armed Forces-
enter 'commissioned officer' or 'other rank' as appropriate at a,
and leave
b
blank.
Civil servants-
give grade
at a
and discipline or specialism, for example: 'electrical engineer'; 'accountant';
'chemist'; 'administrator' at b.
a Full
job title
b Main
things done in job
16
Name and business of employer (if self-employed give the name and nature
of business)
At a, please give the name
of the employer. Give the trading name if one is used. Do not use abbreviations.
At b, describe clearly what
your employer (or yourself if self-employed) makes or does (or did).
Armed Forces - write 'Armed
Forces' at a and leave b blank. For a member of the Armed
Forces of a country other than the UK -add the name of the country.
Civil Servants - give name
of Department at a and write 'Government Department' at b.
Local Government Officers -
give name of employing authority at a and department in which employed
at b.
a Name of employer
b Description of emplyer's business
17
Address of place of work
Please give the full address of your
place of work.
If employed on a site for a long period,
give the address of the site.
If not working regularly at one place
but reporting to a depot or other fixed address, give that address.
If not reporting daily to a fixed
address, tick box 1.
If working mainly at home, tick box
2.
Armed Forces - leave blank.
Please write full address and
postcode of workplace below in BLOCK CAPITALS
Postcode
.
.
.
.
.
.
.
.
No fixed place
1
Mainly at home2
18
Daily journey to work
Please tick the appropriate box to
show how the longest part, by distance, of your daily journey to work
is normally made.
If using different means of transport
on different days, show the means used most often.
Car or van includes three-wheeled cars
and motor caravans.
British Rail train
1
Underground, tube, metro
2
Bus, minibus or coach (public or private)
3
Motor cycle, scooter, moped
4
Driving a cae or van
5
Passenger in a car or van
6
Pedal cycle
7
On foot
8
Other
9 please specify
Work mainly at home
0
19
Degrees, professional and vocational qualifications
Have you obtained any qualifications
after reaching the age of 18 such as:
-degrees, diplomas, HNC, HND, -nursing qualifications -teaching qualifications (see
* below), -graduate or corporate membership
of professional institutions, -other professional, educational
or vocational qualifications?
Do not count qualifications normally
obtained at school such as GCE, CSE, GCSE, SCE and school certificates.
If box 2 is ticked, write in all qualifications
even if they are not relevant to your present job or if you are not working.
Please list the qualificaitons in
the order in which they were obtained.
* If you have school
teaching qualifications,
give the full title of the qualifications, such as 'Certificate of Education'
and the subject(s) which you are qualified to teach. The subject 'education'
should then only be shown if the course had no other subject specialisation.
NO- no such qualifications
1
YES- give details
2
1 Title
Subject(s)
Year
Institution
2 Title
Subject(s)
Year
Institution
3 Title
Subject(s)
Year
Institution
4 Title
Subject(s)
Year
Institution
Declaration
This form is correctly completed to the best of my
knowledge and belief.