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Uber Employment Relationship Questionnaire
Uber Employment Relationship Questionnaire
Uber Employment Relationship Questionnaire
NAME OF INDIVIDUAL:
ADDRESS 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.
locale did you serve while driving for Uber? (Check all that apply.)
____________Bay Area
____________Los Angeles/Southern California
____________Other (please specify):
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
____________________________________________________________________________________
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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
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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
requirement.____________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
__
31. How often did you receive customer comments from Uber about your performance
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
_________________________________________________________________________________________
_____________________________________________________________________________________
52. Do you know what Rasier, LLC is? If yes, what is Rasier LLC?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
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_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
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
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
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?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
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.
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.
81.
( ) No
82.
( ) Yes
83.
84.
85.
86.
As an Employee?
87.
88.
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
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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