Questionnaire Text

Questionnaire form view entire document:  text  image
[Only on Form 2]
c. Where did he work last week?

If he worked in more than one place, print where he worked most last week.
If he travels about in his work or if the place does not have a numbered address, see instruction sheet.
(1) Address (Number and street name)______________
(2) Name of city, town, village, etc.
(3) Inside the limits of this city, town, village, etc.?
[] Yes
[] No
(4) County
(5) State ______________________
(6) Zip Code ____________________

"For a person who travels about in his work or who works in more than one place -- If he usually checks in or out at the same place every day, give the address of that place. If he does not check in or out at the same place, give the address of the place where he worked the most hours last week.

"Give the exact address of the location or branch where he works if his employer operates in more than one location (such as a grocery store chain or public school system). When you cannot give the number or street name, print the name of the building, if any, or the name of the company for which he works."