Apply to be a Provider/Caregiver online by filling out the form below.

PLEASE BE AWARE of the following steps to complete your application:

  1. Complete the online application;
  2. You will then need to contact the Provider Care at Home office on (512) 212 1402;
  3. Schedule a visit to us at 1714 Fortview Rd Suite 106E with a copy of your Social Security and Drivers License/Texas ID;
  4. Complete the new employee orientation in the Provider Care at Home Office.

Caregiver/Provider Application Form

Step 1 of 16

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  • Provider Care at Home is an equal opportunity employer. We will not discriminate and will take affirmative action measures to ensure against discrimination in employment, recruitment, advertisements for employment, compensation, termination, upgrading, promotions, and other conditions of employment against any employee or job applicant on the bases of race, color, gender, national origin, age, religion, creed, disability, veteran’s status, sexual orientation, gender identity or gender expression. However, this does not imply that the applicant will be hired for caregiving services.
  • Information



  • Social Security #: _________________________ (Office Use Only)
  • Date Format: MM slash DD slash YYYY
  • The number of dependents you would like to declare for tax.
    Please enter a number from 0 to 99.
  • Date Format: MM slash DD slash YYYY
  • DO NOT include convictions that have been sealed, expunged, or statutory eradicated.
  • Please enter a number from 0 to 100.