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EMPLOYMENT RELATIONSHIP QUESTIONNAIRE:

NAME OF THE PRINCIPAL:

NAME OF INDIVIDUAL:

ADDRESS OF INDIVIDUAL:

SOCIAL SECURITY NUMBER OF INDIVIDUAL:

Date Worked:

From:

End:

This information is needed to determine whether the individual identified above is/was an employee for the purpose of the Unemployment
Insurance, Disability Insurance and Personal Income Tax Withholding programs. It is submitted for the use of the Employment Tax Branch.
NOTICE: All items must be answered, or marked Unknown or Do not apply. If the spaces provided are not adequate, attach additional
sheets as necessary. If you need help in completing this form, please call Janet Man, Tax Auditor at (510) 877-4838.

1. What services did you provide to


Uber?:____________________________________________________________________________________
_______________________________________________________________________________________
2. How did your relationship with Uber begin? (Job ad, referral,
etc,.)_____________________________________________________________________________________
_________________________________________________________________________________________
3. What steps did you take to become an Uber driver?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
____________________________________________________________________________________
4. Did Uber require you to submit any of the following documents?
a. Fill out an online application Yes_____No________
b. Submit/upload documents such as Drivers license, Vehicle Registration, Insurance Paperwork
Yes______No_______
c. Vehicle Inspection Certification Yes____No______
d. Background Check Yes_____No________
e. Direct Deposit Yes________No_______
f. Other:______________________________________________________________________________
___________________________________________________________________________________
5. Did you have commercial automobile insurance?
a. Yes______
b. No_______
6. Did Uber require minimum insurance coverage? If yes, what coverage did they require?
________________________________________________________________________________________________
________________________________________________________________________________________________
__________________________________________________________________
7. Did Uber require that it or Rasier, LLC be named as an additional insured on your insurance policy?
_________________________________________________________________________________________
____________________________________________________________________________________
8. Do you currently drive for Uber?
a. Yes______
b. No_______
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9. What type of driving service did you provide for Uber?


a. -----------Uber X
b. ------------Uber XL
c. -----------UberBLACK
d. -----------UberSUV
e. -----------UberTAXI
10. Which
a.
b.
c.

locale did you serve while driving for Uber? (Check all that apply.)
____________Bay Area
____________Los Angeles/Southern California
____________Other (please specify):

11. How long have you driven for Uber?


a. _______1-3 months
b. _______3-9 months
c. _______12 or more months
d. _______Other
12. While driving for Uber, did you drive for any other companies?
a. _______Yes
b. _______No
13. Which company(s) did you drive for while working for Uber?
a. ______Lyft
b. ______Sidecar
c. ______Other (please specify):
14. Did Uber require you to take any training?
a. _____Yes
b. _____No
15. How frequently did you take the Uber training?
a. _____Daily
b. _____Weekly
c. _____All at once
d. _____I set my own schedule for the training
e. _____Other (please describe):
16. Overall, how many hours of training did you receive from Uber?
a. _____Less than 10 hours
b. _____10 to 20 hours
c. _____21 to 30 hours
d. _____31 to 40 hours
e. _____Over 40 hours
17. What type of trainings did you receive from Uber?

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
____________________________________________________________________________________

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18. Do you have copies of the training materials that Uber provided to you?
a. Yes______
b. No______
19. What equipment, tools, or applications did you use to drive for Uber?

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
20. Who provided the equipment, tool, or application listed below?

Provide
d by
Uber

Provided
by me

Provided by a
third party

Mobile phone
Uber
application
Equipment to
track miles
driven for
customers
Vehicle
Other

21. Did you pay fees for the use of the equipment /application/vehicles/GPS? If so, what fees

did you pay and how did you pay these fees?
a. _______Yes
b. _______No

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
22. What type of vehicle did you drive for Uber? Please list maker, model and year of

vehicle?
_________________________________________________________________________________________
_________________________________________________________________________________
23. What assistance, if any, did Uber provide to help you lease or purchase the vehicle you

drove for Uber?


a. _______Does not apply/used own financed car
b. _______Referral to automobile dealership(s)
c. _______Referral to a lender or auto lessor
d. _______Other assistance (please
describe/terms):__________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___

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24. Did Uber provide you with any policies/procedures/instructions on how to use the Uber

App? If yes, please provide copies of the documents that Uber provided. Briefly
describe the steps taken to complete a trip, from acceptance to drop off of the
passenger.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
25. Please provide information on how fee (fare) schedule is set up for

compensation.__________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
___
26. Who created the fee schedule for compensation you receive from Uber?
a. ________Uber
b. ________I created the fee schedule
c. ________Other (please

specify):__________________________________________________________________________
___________________________________________________________________________________
__
27. Did the fee schedule change?
a. ________Yes (Please tell us how often the fee schedule changed):

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
b. ________No, the fee schedule did not change.
28. Who initiated the change?
a. _________Uber
b. _________I initiated the change
c. _________Other (please

specify):__________________________________________________________________________
___________________________________________________________________________________
__
29. Did you receive customer comments from Uber about your performance based on Ubers

star rating system?


a. _________Yes
b. _________No
30. Please explain your understanding of star rating system and minimum

requirement.____________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
__
31. How often did you receive customer comments from Uber about your performance

based on Ubers star rating system?


a. _________Per service trip
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b. _________Other frequency (please specify):


32. Did you alter your performance in response to the star rating comments?
a. ________Yes
b. ________No
33. Did you receive notices from Uber regarding the activity or progress on your driving

account?
a. ________Yes
b. ________No

34. How often did you receive notices from Uber regarding the activity or progress on your

driving account?
a. ________Daily
b. ________Weekly
c. ________Other frequency (please
specify):__________________________________________________________________________
__
35. Did you alter your performance on the basis of the notices received from Uber?
a. ________Yes
b. ________No
36. Please describe any actions you took in response to the

notices._________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
__
37. Do you know of any repercussion or action taken by Uber if your star rating fell below

minimum standard?
_________________________________________________________________________________________
________________________________________________________________________________
38. Are you required to pick up passengers?
a. ________yes
b. ________No
39. Are you paid if you do not pick up passengers?
a. ________Yes
b. ________No
40. Are you allowed to pick up only passengers dispatched through Uber application?
a. _________Yes
b. _________No
41. Are passengers required to use Ubers proprietary software to request for a ride?
a. _________Yes
b. _________No
42. Are you required to accept a certain number of rides?
a. ________Yes
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b. ________No
43. Are you notified via email/text/communications from Uber regarding acceptance rate?
a. ________Yes
b. ________No
c.
44. If you are notified about acceptance level; what is your understanding of the acceptance

rate?
_________________________________________________________________________________________
_________________________________________________________________________________________
_____________________________________________________________________________________
45. Do you know what hours driven during busy hours means? If yes, what does it mean?

____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

46. Are you notified via email/text/communications from Uber regarding hours driven during

busy hours?
a. ________Yes
b. ________No
47. If you are notified about hours driven during busy hours ; what is your understanding of

the significance of the busy hours?


_________________________________________________________________________________________
_________________________________________________________________________________________
____________________________________________________________________________________
48. Is there a minimum number of rides required for you to complete to maintain your account active? What kind
of communications/emails do you receive regarding activity? If you have copies, please provide.
a. ______________Yes
b. ______________No. Please
explain.____________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
49. Do you collect fees from passengers?
a. _________Yes
b. _________No
50. Are you allowed to accept tips directly from the passenger?
a. _________Yes
b. _________No
51. What is Ubers policy regarding tips?

_________________________________________________________________________________________
_____________________________________________________________________________________
52. Do you know what Rasier, LLC is? If yes, what is Rasier LLC?

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
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53. Do you know why you are paid by Rasier, LLC?

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
54. Did you choose to be paid by Rasier, LLC?

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
55. How often are you paid by Uber? Please explain payment method. Is there another

option of payment beside direct deposit?


_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
56. What kinds of deductions are taken out prior to final payment? Please explain.

a)
b)
c)
d)
e)

__________Uber fees
__________Expenses
__________Bridge Tolls
__________Airport Fees
__________Safety (Rider) Fees

57. What percent of fare fees are deducted as Uber fees? Are you able to negotiate Uber

fees?
_________________________________________________________________________________________
_________________________________________________________________________________________
_____________________________________________________________________________________
58. Are you required to perform services personally?
a. ___________Yes
b. ___________No
59. Once you agreed to drive for Uber could you have someone else drive passengers under

your Uber account?


a. ______Yes
b. ______No
60. Can Uber terminate your service at will?
a. ______Yes
b. ______No
61. Can you quit working for Uber at any time?
a. ______Yes
b. ______No
c.
62. Did company cover you for any accidents or mishaps while you performed service as a

driver?
_________________________________________________________________________________________
_________________________________________________________________________________________
___________________________________________________________________________________
63. Do you share in the companys profits or losses?
a. _______Yes
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b. _______No
64. Do you have a financial investment in the Company?
a. _______Yes
b. _______No
65. Did you perform/represent your services under the companys name?
a. _______Yes
b. _______No
66. Did Uber provide you with a logo/sign to post on your vehicle while you drove for Uber?

Who provided you with the sign?


_________________________________________________________________________________________
___________________________________________________________________________________
67. Did you sign any contract (s) with the Company?
a. _________Yes, (If yes, please attach a copy)
b. _________No
68. Who did you sign a contract with?

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
69. Did you negotiate the terms of the contract?
a. Yes_______
b. No_______
70. Did you read the contract?
a. Yes_______
b. No________
71. Did you speak to a representative of Uber about the Contract?
a. Yes________
b. No_________
72. Did you speak to a representative of Rasier, LLC about the contract?
a. Yes__________
b. No___________
73. Earlier if you indicated you no longer drive for Uber, please describe how the relationship

ended.__________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_
74. Earlier if you indicated that you received star rating or other performance based notices

from Uber, do you have copies of star rating or other performance based notices you
received from Uber? Please include a sample if you answered yes to the question.
a. _________Yes
b. _________No
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75. Uber treats it drivers as independent contractors. If you believe you were an independent contractor with
respect to your driving related to Uber, Please explain why.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
76. Please answer yes or no to following statements and elaborate if necessary.
a.
b.
c.
d.
e.

_______Uber informed me that I will be providing service as an independent contractor.


_______I did not have an option to provide service as an employee.
_______I had no option to refuse or alter online/written agreement.
_______I was informed I will be responsible to pay my own taxes.
_______I do not know the material difference between an employee and an independent contractor.
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

77. Did you pick up or drop off passengers at any airports? If yes, which airports?
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
78. Do you have authority from the airport to pick up and drop off passengers at the airport? If yes, from whom?
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
79. Did Uber ever communicate with you about picking up or dropping off passengers at the airport? What did
Uber tell you about picking up or dropping off passengers at the airport?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
80.

Do you have a business license #

81.

Do you have your own business cards? ( ) Yes

( ) No

82.

Do you advertise your services to the general public?

( ) Yes

83.

If yes, list sources of advertisements (Newspapers, Yellow Pages, Flyers, etc.):

84.

Do you provide similar services for other companies?

85.

If yes, please list the names of the companies:

86.

As an Employee?

87.

Please provide % of time spent working with this Company

88.

Please provide % of monies earned with this Company

89.

Do you have another occupation aside from working for Uber or related companies as a driver?
( ) Yes
( ) No

Federal Tax ID #

( ) Yes

as an Independent Contractor (

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( ) No

( ) No

)
with other companies

with other companies

a. ___________as an employee or
b. __________ Independent contractor.
Pleas list type of
job/s.______________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
ADDITIONAL COMMENTS:
Department will contact you if it needs additional information or clarification.
Thank you for your cooperation.
I declare that all copies of contracts and all statements submitted are true, correct, and complete to the best of my
knowledge and belief.
Name:

Sign/Date:

Title:

Telephone Number:

Address:

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