Serving Greater New Orleans
New Orleans, LA

(504) 486-5044
help@dependablecare.net

Business Hours: 24/7
8am - 8pm Access Coordinators Available

Hotel Babysitting Caregiver Application for Greater New Orleans

We require at least TWO years of experience as a child caregiver. Some examples of child care experience: a private home as a babysitter or nanny on a consistent basis, employment in a daycare center, preschool, or elementary school, etc. Should your application be approved, Dependable Kid Care (DKC) will conduct employment verifications.

You may complete this online below, or download this form as a printable PDF.


    Applicant Information
    Name: Last First M.I.
    Mailing Address: Apt.: D.O.B.:
    City: State: Zip:
    Phone:
    Email:
    Additional Contact #:
    Social Security No.:
    Have you ever been on this registry before? YesNo If yes, when?
    Have you ever been convicted of a felony, other than a traffic violation? YesNo If yes, explain:
    Education
    High School: Address:
    From: to Did you graduate?: YesNo Diploma:
    College: Address:
    From: to Did you graduate?: YesNo Diploma:
    Other: Address:
    From: to Did you graduate?: YesNo Diploma:
    History
    Do you have any physical limitations that will prevent you from performing daily tasks?: YesNo
    If yes, please explain:
    Do you smoke? YesNo
    Do you own a vehicle? YesNo Is the vehicle a:
    Do you have car insurance? (Proof of insurance required)YesNo
    Are you available: Full-timePart-timeOccasionally Are you available: Mon-FriSat & SunHolidays
    Please check any of the following shots/immunizations that you have received?Pertussis (aka Whooping cough)TB testHepatitis BTetanusInfluenza (Flu)
    Emergency Contact
    Name: Phone #:
    Relationship to you: Email:
    References

    Please list three professional references (e.g. a current or previous supervisor).

    Name: Phone #:
    Professional Relationship: Email:
    Name: Phone #:
    Professional Relationship: Email:
    Name: Phone #:
    Professional Relationship: Email:
    Previous Employment
    Company: Phone:
    Address: Supervisor:
    Job Title: Starting Salary Ending Salary
    Responsibilties:
    From: To: Reason for Leaving:
    May we contact your previous supervisor for a reference? YesNo

    Company: Phone:
    Address: Supervisor:
    Job Title: Starting Salary Ending Salary
    Responsibilties:
    From: To: Reason for Leaving:
    May we contact your previous supervisor for a reference? YesNo

    Company: Phone:
    Address: Supervisor:
    Job Title: Starting Salary Ending Salary
    Responsibilties:
    From: To: Reason for Leaving:
    May we contact your previous supervisor for a reference? YesNo

    I certify that all information given herein is true and correct to the best of my knowledge. I authorize any investigation of all statements and information contained in this application for referral which is necessary to be considered for referrals through the DKC registry. I understand that I may be immediately dismissed without further obligation from the client I have been referred to. I also understand that Dependable Nursing & Family Care, Inc. (dba Dependable Kid Care) acts as a facilitator in my placement. I agree to hold DNFC, Inc. harmless and to indemnify DNCF, Inc. for and from any and all claims, including attorney fees and court costs made by any person related to my placement.

    If this application leads to my acceptance on the registry, I understand that false or misleading information in my application may result in my immediate release from the registry and future eligibility.

    DNFC, Inc. reserves the right to refuse any applicant for placement.

    Signature of Applicant: (Initials)