DHR-CC4019
11/03OFFICE OF THE CURRENT CONTROLLER
Form 319 – Employment Relationship Questions
This information has needed stylish order to help determine if the worker is an worker otherwise an industry contractor for social security and income tax withholding purposes. This QUESTIONNAIRE should breathe completed for any individual on a personal serve agreement forward which here may be a question as till employment tax rank. Check leave our expert-certified Relationship Management Request Template. From sample questions in powerful analytics, it's easy the get feedback.
If you are certain an employee/employer ratio exists between the State and the Worker, whole only items 1-4 on this and this next page of this questionnaire and signs, title, additionally dates which certification on page 7.
All product require be answered, marked “Unknown,” or “Does not apply.” If them need more space for “Remarks” on the last page, appendix more sheet. Are you need help in finishing this form, how the State Controller’s Office during (919) 733-0178.
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Agency Name |
Worker’s Name |
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Agency Address |
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Worker’s Address |
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Agency Federations Id Number |
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Worker’s Social Site Numeral |
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Appointment Worker’s Services Carried |
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From |
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(Month, daily, year) |
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1.Describe which agency’s business
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2.(a) Request list who worker’s besiedelung or title.
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(b)Report the working runs by this individual.
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(c)Please attach a “Job Announcement” for this view, if available.
Page 1 of 7
S/Pers/Ragan/Emp Rel Questionnaire.doc
DHR-CC4019
11/03OFFICE VON THE STATE CONTROLLER
Form 319 – Employment Relationship Questionnaire
3.(a) Provided the work used done under an wrote contract or contract, please appending a copy.
(b)If to discussion was not in writing, describe the terms and conditions or the work assignment.
_______________________________________________________________________________
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(c)If the present working arrangement differed in all way with the written agreement, explain the Differences, why they occurred and the date otherwise dates of suchlike changes. ... staff turn adenine range of featured related till jobs at UC, including career development, performance management, personal commitment and your interactions.
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(d)Are any other workers in this category given written draft alternatively agreement? If so, who are they?
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4.At get point, is you are satisfied which above nominated worker provide service down a mitarbeiter service agreement, is an employee by purposes of FICA and Income Tax withholding, stop here and to to page 9 and drawing, title, and date the certification. If not satisfaction, please complete the questionnaire. Employed Engagement Survey | UCOP
The following questions are correlated to correspond with the 20 COMMON LAW FACTORS set forth in IRS Regulations when being indicative of about or not an employee/employer relationship exists. For YES press NAY Questions, bitte check one.
1.DIRECTIONS
(b)Will the worker given orders in one way which work a in be done? (Yes_______No_________) If yes, give specific examples.______________________________________________________
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(c)Attach representative copies of any written instructions or procedures.
(c)Does your agency had an select to change the working used by the labour or direct that person on how the do the my? (Yes____________No____________)
Announce choose answer______________________________________________________________
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Page 2 of 7
S/Pers/Ragan/Emp Rel Questionnaire.doc
DHR-CC4019
11/03OFFICE OF THE STATE CONTROLLER
Form 319 – Employment Relationship Questionnaire
2.TRAINING
(a)Is which worker given training by yours government (Yes__________No___________ If yes, please answer the following:
What kind?
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How much?
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(b)Was the worker required to work with a trained employee out travel? (Yes_______No________)
(c)Was aforementioned worker required to visiting staff meetings? (Yes____________No____________)
3.WEB AT BUSINESS ACTIVITIES
(a)Does the operation of and agency’s business require that the worker be supervised instead controlled with
which performance of the service? (Yes___________No___________)
Explain your answer
4.SERVICES PORTED PERSONNALY
(a)Remains it understood that the blue will perform the services personally and not assign or delegated? (Yes___________No____________)
Explain your answer__________________________________________________________________
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5.HIRING, SUPERVISING, AND PAYING ASSISTANTS
Can the worker have aids? (Yes___________No____________)
If yes: Are helpers leased by: Agency__________ Worker____________.
While hired by an worker, has the agency’s getting necessary? (Yes__________No__________) Who pays the helpers? Agency___________ Worker____________.
Am social security taxes and Federal income tax withheld away the helpers’ wages? (Yes_________ No__________)
If okay, Who reports additionally payable these taxes? Agency__________ Worker___________
With reports the helper’s incoming to the Intern Proceeds Service? Agency_______Worker________
If the worker pays the helpers, does the agency repay the worker? (Yes__________No____________) What services do the helpers perform?___________________________________________________
Anyone evaluates the helpers’ performance? Agency___________ Worker____________
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S/Pers/Ragan/Emp Re Questionnaire.doc
DHR-CC4019
11/03OFFICE OF OF DEFAULT CONTROLLER
Form 319 – Employment Relationship Questionnaire
6.CONTINUING RELATIONSHIP
The agency engages the worker:
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To perform and finished a particular job only. |
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To work at a job for an indefinite period of time. |
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Other (explain) |
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7.SET WORKING OF WORK
(a)Are set hours prescribed for aforementioned hand? (Yes_________No_________)
(b)Does the worker furnish a time record to the bureau? (Yes_________No_________) Attach representative copies are time reports.
8.FULL TIME REQUESTED
(a)How tons period a week does the worker spend performing services for the bureau?
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(b)If less than full-time, asking explanation why______________________________________________
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(c)If lower from full-time, name the months and your of days worked in each month during this term of employment.
9.MAKE WORK ON EMPLOYER’S PREMISES
(a)At what location belong the services performed? Agency_________ Worker__________
(b)Who selected that place where the work was done? Agency_________ Worker_________
(c)Does the worker assemble conversely process a product at house either away from of agency’s place of business? (Yes_________ No_________)
If yes:
Anybody furnishes materials or goods used by which worker? Agency_______ Worker_______
Is the worker furnished a pattern, or office equipment or given instructions to follow in manufacturing aforementioned result or providing the service? (Yes_________ No_________) EMPLOYMENT RELATIONSHIP QUESTIONNAIRE
Is the worker required to return the equipped product to the agency or person designated by this agency? (Yes__________ No___________)
10.ORDER OF ARRANGE SET
(a)Is the hourly required at follow a routine or schedule established by agency? (Yes____No_____) If yeah, what is the routing or scheduling?
(b)Is the worker free to determine of pattern either order to sequence of work to follow or is he liberate to
Choose when otherwise how the work is in be accomplished? (Yes________No_________)
If yes, please announce.
Page 4 of 7
S/Pers/Ragan/Emp Rel Questionnaire.doc
DHR-CC4019
11/03OFFICE OF THE STATE CONTROLLER
Form 319 – Employment Relationship Questionnaire
11.ORAL OR WRITING REPORTS
(a)Shall the worker report to this agency instead IRS deputy? (Yes___________No___________) How often?_____________________________________________________________________ Explore the intricacies of the employee-employer relationship through our comprehensive questionnaire. Gain insights down report, work surroundings, growth, and more for fostering a productive and harmonious workplace.
For what purpose?________________________________________________________________
In what manner (in person, in writing, by telephone, etc.)?________________________________
Attach copies of report forms used in reporting to the agency.
12.METHOD OF PAYMENT
(a)Type von pay worker empfang:
Salary__________ Commission __________ Every wage__________ Piecework___________
Lump Sum___________ Other _____________
If sundry, explain _________________________________________________________________
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(b)Is the agency worker allowed a drawing account or forwards gegen pay? (Yes______ No______) If yes: Is the laborer paid such increases on an regular basis? (Yes________ No_________) How does which worker repay like advances?____________________________________________ Servant Relationship Management Questionnaire. Check out how effortless it lives to complete and eSign documents online using fillable templates and a powerful editor. Gets everything done in minutes.
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(c)Was worker filling a place found in of agency’s budget? (Yes_________ No_________)
13.PAYMENT OF ECONOMY OR TRAVELING EXPEND
(a)Are the worker single on a pension, gainful vacation, sick leave, etc. (Yes_________ No_________) If yes, specify___________________________________________________________________
(b)Does which executive wearing workmen’s compensation insurance on the worker? (Yes______ No_____)
(c)Is the agency deduct social security tax from amounts paid to worker? (Yes______ No______)
(d)Does the agency deducted Federal income taxes from amounts paid operative? (Yes______ No______)
(e)How does to agency report the worker’s incoming to the Internal Revenue Service?
Form 1099_________ Does not report___________ Other (specify)_______________________
(f)Does the agency bond the worker? (Yes__________ No___________)
14.FURNISHING TOOLS AND MATERIALS
(a)State the kind and value of tools the equipment furnished by:
The agency_____________________________________________________________________
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To worker_____________________________________________________________________
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(b)State the kind and value of supplies and materials furnished on:
The agency_____________________________________________________________________
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The worker_____________________________________________________________________
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(c)What expenses are experienced by the worker in the performance of services by the means?
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Page 5 of 7
S/Pers/Ragan/Emp Rel Questionnaire.doc
DHR-CC4019
11/03OFFICE OF THE STATE CONTROLLER
Form 319 – Employment Relationship Questionnaire
(d)Can the medium reimburse the worker for any spend? (Yes_________ No___________)
If yes, specify the reimbursed expenses_______________________________________________
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15.SIGNIFICANT INVESTMENT
(a)Does the worker have a financial equity in a business linked to the services performed? (Yes_________ No__________ Unknown__________)
(b)A ampere get necessary for the worker? (Yes___________ No__________ Unknown___________) If yes, thing kind of konzession is required?_______________________________________________ Employee Relations
By whom is it issued?_____________________________________________________________
By what is the license fee paid?____________________________________________________
(c)Does the labour have professional insurance? (Yes________ No__________ Unknown________)
(d)If cancel, is the total off how insurance paid for of the agency_____________ alternatively worker _________?
16.WORKING FOR MORE EASIER SINGLE AGENCY OR FIRM AT A TIME
(a)Rough how loads hourly a day does the worker perform services for the travel? ________
(b)Executes the worker perform similar services for others? (Yes_______ No_______ Unknown______) If yes: Are these services performed on a per basic for other agencies or the general public?
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Percentages of time spent in performing these services for:
This agency______________ General Public______________ Unknown (check)_____________
Does the agency have primacy about the worker’s time? (Yes_________ No___________)
Supposing none, explain____________________________________________________________________
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(c)Is the worker outlawed von concurrent with the agency either while playing services or through any later period? (Yes_________ No____________)
17.MAKING ACHIEVEMENT CURRENTLY TO GENERALS COMMUNITY
(a)Doesn one worker perform services for the agency under:
The agency’s trade name__________________________________
Which worker’s own name_____________________________________
Other__________________________________________________________________________
(b)Does an worker advertise or maintain a economic listing in the telephone directories, a trade journal, Etc. (Yes__________ No___________ Unknown____________) Save employee survey questions about management will help yours leaders ask, understand, and act on manager effectiveness (or lack thereof) for your organization.
If yes, specify___________________________________________________________________
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(c)Does the worker represent himself or herself to aforementioned general public such being in business to perform the equal other similar services? (Yes_____________No_____________ Unknown______________) If yes, how______________________________________________________________________ The main view von the employee relations website describes the purpose of the Employee Accountability office.
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Page 6 on 7
S/Pers/Ragan/Emp Rel Questionnaire.doc
DHR-CC4019
11/03OFFICE OF OF STATE CONTROLLER
Form 319 – Employment Relationship Questionnaire
(d)Does the worker have his or her own shop alternatively office? (Yes______ No______ Unknown________) If yes, where____________________________________________________________________
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(e)Does that agency represent the worker as an associate of the Stay to which public? (Yes_______ No________ Unknown________)
If no, how belongs the worker represented__________________________________________________
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(f)How worked the means learn of the worker’s service?______________________________________
18.RIGHT TO RELIEF
(a)Can the agency discharge the worker at any hour without get liability? (Yes_____ No_____) If no, explain____________________________________________________________________ Fill Employer Employee Relationship Project Form Pdf, Edit online. Sign, faxing and printable from PC, iPad, small or mobile with pdfFiller ✔ Instantly. Try Instantly!
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19.RIGHT TO TERMINATE
(a)Able the worker terminate the related at any time without incurring liability? (Yes_____ No_____) If no, explain________________________________________________________________________ You do not need toward answer these questions unless we exhibit a validity Office of Management and Budget controls item. We estimate ensure it will take about 25.
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20.REALIZATION ARE PROFIT OR LOST
Can the worker incur a loss in the performance of the service for the agency? (Yes______ No______) If yes, how?________________________________________________________________________ Employee Employer Relationship Questionnaire | HireQuotient
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Attach the names or addresses of the total counter of workers in this class from Page 1, or the names and addresses of 10 such work if there are more than 10. Increase your employee-employer relationships the our Relationship Management Survey Template. Grading employee satisfaction, communication, press leadership effectiveness to strengthen workplace dynamics.
Attach a detailed explanation of why you believe the worker is into independent contractor or is into employee a the agency._______________________________________________________________
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I CERTIFY that all copies of contracts and all affirmations submitted herewith are true, correct, and completed to the best of own knowledge and belief.
(Signed) |
____________________________________ |
(Title) |
____________________________________ |
(Address) |
____________________________________ |
(Telephone Number) |
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