1. Name of Employer, ____
2. Post Office, ____ 3. County, ____
4. State, ____ 5. Date, ____
6. Do you live in a city, in a town, or in the country? ____
7. Estimated present population of city or town, ____
8. Leading industries of city or town, ____
9. Are women and girls employed in these industries? ____
10. Estimated total number so employed, ____
11. Are women and girls employed as clerks? ____