Chief occupation or trade
Employment other than chief
occupation or trade, if any.
Employer
Employee
Working on own account
State where person employed,
as “on farm”, “in woolen mill”,
etc.
Weeks employed in 1910 at
chief occupation or trade
Weeks employed in 1910 at
other than chief occupation
Hours of working time per week
at chief occupation
Hours of working time per week
at other occupation
Total earnings in 1910 from
chief occupation or trade
Total earnings in 1910 from
other than chief occupation or
trade
Rate of earnings per hour when
employed by hour cents
Upon life $
Against accident or sickness $
Cost of insurance in census
year $
Months at school in 1910
Can read
Can write
Language commonly spoken
Cost of education in 1910 for
persons over 16 at college,
convent or University
Blind
Deaf & dumb
Crazy or lunatic
Idiotic or silly
Line
Family, household or
institution
1
2
NOTES:
Numbered
in the order
of visitation
3
4
5
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6
Profession, occupation, trade or means of living
8
9
10
Wage earners
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12
13
Insurance held at date
14
Religion
Nationality
Residence and Personal Description
Racial or tribal origin
Year of naturalization if formally an
alien
11
Year of immigration to Canada if
an immigrant.
Country or place of birth (If in
Canada specify province or
territory)
Age at last birthday
7
Year of birth
Fifth Census of Canada, 1911
Month of birth
Single, married, divorced or legally
separated
; S. District #:
Relationship to head of family or
household
; District #:
Sex
Place of habitation (Range or
concession & cadastral # if in
Township or parish. Street &
house # if in city, town or village)
Name of each person in family,
household or institution
Dwelling House
Line
Province:
Page;
; Poling sub-division #;
in
, (city, town, village, twp. or parish)
Nominal Return of Living Persons by:
, Enumerator
Schedule No. 1. Population by Name, Personal Description, etc.
Citizenship, Nationality and Religion
Page #:
15
16
Education & language of each
person five years & over
Specify age when
infirmity appeared
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41