Thank you for your interest in working with Professional Caretakers!

We’re a family-owned, licensed home health care agency, and we’re looking for great Caretakers:
HHAs / CNAs / PAs / Companions / Homemakers


Natural Caretaking Talent
Clean Criminal Check
Positive Attitude
Clean Drug Test
Texas Drivers License
Dependable car
I have my job history information available and can finish the whole process at this time.

What is your first name? *

Asterisk=REQUIRED!  You can skip asterisked questions, but they must be answered before you can submit your app.
Hi {{answer_35927560}}. Middle initial? *

One capital letter, no period.
Last name? *

What other names have you used, including your maiden name?

Privacy *

At Professional Caretakers we take the security and privacy of our applicants very seriously. We protect all your data, including your social security number. 

For additional security, we use Typeform, a third party secure site that maintains our application form.  Your data is protected by Amazon AWS and TLS (the latest SSL)

Be assured your application data is private and please continue?

Policy *

These policies describe how Professional Caretakers (PCI, we, or us) offers its application process to you (you, user, applicant) for potential employment.


This application is voluntary and you are not required to provide any personal information unless you choose to.  If you do not wish to provide information, exit now and discontinue use of our application.
The Electronic Signature of each User shall be personal and non-transferable.  The User is obliged to inform PCI of any changes to his application data and is responsible for preventing unauthorized access and/or use of his Electronic Signature by a third party on his or her behalf.  The User shall be responsible for using the Services properly and safekeeping their Electronic Signature. 

Applicants are advised that disclosure of an employee’s social security number (SSN) is required as a condition for employment within Professional Caretakers, Inc.  in view of the practical administrative difficulties which would be encountered in maintaining adequate employee records without the continued use of the SSN. The SSN is used to verify the identity of the applicant, and as an account number (identifier) throughout any period of employment in order to record necessary data accurately. As an identifier, the SSN is used for criminal background check, nurse aide fraud and abuse background check, insurance and disability reporting, Texas Workforce Commission reporting and such other requirements as may arise.We take precautions to protect your information. Only employees who need the information to perform a specific job (for example, background checks, reference checks, etc) are granted access to personally identifiable information. The computers/servers in which we store personally identifiable information are kept in secure physical and network environments.
You agree to indemnify and hold PCI harmless from any claim or demand including reasonable attorneys' fees, made by any third party due to or arising out of your violation of the Terms or your violation of any law or your violation or infringement of any rights of another party.
You have the right to review and get a copy of your information.  If we deny your right to review or copy your records, you have the right to have our decision reviewed.  You may be charged for the copies.  You have the right to ask us to change your application information. However, we will not change any information that we determine is correct, that was created by others, is not part of the information we have about you or is not part of the information you would be allowed to inspect or to copy.  To request a change, please contact us at and provide a reason for the change. 

We may collect usage data, device and application data, cookies and email addresses.  We use that data to assess the performance of our application and to communicate with you.  You may always turn cookies off in your browser and opt out of emails.

Do you wish to accept our policies and continue your application?
ARE YOU SURE??? If you don't accept our online policy, you cannot continue and will have to start over.  Please say YES!

Do you accept our online policy?

TX Drivers License Number *

(8 numbers, no dashes)
Date of Birth *

Social security number *

(9 numbers, no dashes)
Do you have a CNA, LVN, or RN license?

Its ok, we have lots of cases than do not require a license!
Enter your license number

.(numbers only, no dashes)
What is the best phone number to reach you? *

(10 digit number, no dashes)
What Is your home address?

Number and street? *

City? *

State? *

2 digit state code (TX, OK)
Zip? *

5 numbers only
Which one of our Texas cities would you like to work out of? *

What areas of {{answer_35932176}} would you prefer?

(We will always try to assign you close to your zip code above.)
Describe your dream job!

Answer the following sub questions to help describe the ideal job for {{answer_35927560}}.
Your desired rate/hour?

How many hours would you like to work per week?

What are your desired hours?

Live In or Hourly *

Position Applying For? *

Date Available?

Have you applied for employment or been employed by Professional Caretakers, Inc.? *

Do you have relatives or friends working for PCI? *

List Relatives or Friends at PCI.

Caretaking Experience?

How many years (include raising children, taking care of a parent, etc.)  Include where you got your experience.
Did you graduate from high school or have a GED? *

Do you have your own, reliable vehicle? *

You must have your own reliable car. *

What is the make/model/year?
Do you currently use illegal drugs? (PCI tests)

Have you ever been convicted of a felony or subjected to a deferred adjudication on a felony charge? If yes, explain. A conviction may not disqualify you, but a false statment will. PCI checks criminal background and the caregiver fraud and abuse registry as required by the State of Texas. *

If yes to conviction, please explain.

Are you authorized to work in the U.S.? *

Have you ever been fired or forced to resign? *

Explain why your were discharged.

Please have your employment history available OR upload your resume.  Your choice!

Do you want to upload a resume?  We prefer a pdf format.

Employment History - Job 1

Please enter 10 years of Job history with the most recent job first.  You must explain any unemployed periods in the last screen.
Who is the Company or Family you worked for?

Start Date for {{answer_35924802}}? *

End Date {{answer_35924802}}? *

What were your duties at {{answer_35924802}}?

Why did you leave {{answer_35924802}}?

Can we contact {{answer_35924802}}? *

What is the phone number for {{answer_35924802}} *

(10 digit number, no dashes)
Are you done listing all of your employers? *

Employment History - Job 2

Enter 10 years of Job history in any order.  You must explain any unemployed periods in the next screen.
Who is the Company or Family you worked for?

Start Date for {{answer_35924806}}? *

End Date {{answer_35924806}}? *

What were your duties at {{answer_35924806}}?

Why did you leave {{answer_35924806}}?

Can we contact {{answer_35924806}}? *

What is the phone number for {{answer_35924806}} *

(10 digit number, no dashes.)
Are you done listing all of your employers? *

(account for the most recent 10 yrs)
Employment History - Job 3

Enter 10 years of Job history in any order.  You must explain any unemployed periods in the next screen.
Who is the Company or Family you worked for?

Start Date for {{answer_35924810}}? *

End Date {{answer_35924810}}? *

What were your duties at {{answer_35924810}}?

Why did you leave {{answer_35924810}}?

Can we contact {{answer_35924810}}? *

What is the phone number for {{answer_35924810}} *

(10 digit number, no dashes.)
Upload your resume!  It must include the company name, the period you worked  MM/YYYY, the phone number of your employers and whether we can contact them.  

We've got your resume if it appears below:

Describe any other employment that helps you account for the 10 most recent years.

List any special care experience or training you have obtained re: Alzheimer's, Parkinson's, Paraplegia, Strokes, COPD, etc.

List any Periods of Unemployment of 4 weeks or more during the last 10 years.  Include the date and what you were doing?

List at least 1 personal reference up to 3.  

Not relatives and have known you for at least 5 years (even if they are not local). We prefer local.

Reference -1
What is your reference's name? *

Describe your relationship with {{answer_35924814}} *

Phone Number for {{answer_35924814}}? *

Enter only a 10 digit number, no dashes.
Are you done listing all of your personal references? *

Reference - 2

What is your reference's name? *

Describe your relationship with {{answer_35924817}} *

Phone Number for {{answer_35924817}}? *

Are you done listing all of your personal references? *

Reference - 3

What is your reference's name? *

Describe your relationship with {{answer_35924820}} *

Phone Number for {{answer_35924820}}? *

EEOC information is not used or considered in the employment, promotion or other personnel action selection process.

Your response is voluntary and not required for employment purposes but is important to help us comply with EEOC. *


Ethnic Code (please choose one)

Are you a Vietnam era veteran?

Are you disabled?

Applicant's Comments

Tell us more about you!  Explain any answers above or provide additional information that would help in hiring you.
Essential Disclosures

I understand that in the event I am employed, the first six months of my employment are probationary. I also understand that I am eligible for overtime under provisions of the Fair Labor Standards Act all hours I work in excess of 40 in a work week will be paid at time and one half. I understand that if I am male, I am required to sign a Certification of Registration Status for the Selective Service as a requirement for employment. I further understand that if I am a male age 18 through 25, I must show proof of registration with Selective Service at the time of hire. I understand that any offer of employment is contingent upon my completing the Immigration and Naturalization Service Employment Eligibility Verification (Form I-9) and providing documents to verify my identity and employment eligibility as required by law. When completing the Form I-9, I will be required to attest that I am a citizen or national of the US, a lawful Permanent Resident or and alien authorized to work. I certify the statements made by me in this application are true, complete and correct to the best of my knowledge and belief and are made in good faith. I understand that any false statement made herein will void this application and any actions based upon it. I agree to revise this application should any of the information change. I authorize PCI to make reference checks relating to my employment and a drug screening test. I understand that this application and all attachments are the property of Professional Caretakers, Inc.
Signature *

Date Signed *

Ready to Submit?  After you hit the red "Continue" button, you will not be allowed to go back to make changes.

{{answer_35927560}}, thank you for applying! Your Application will remain active for 60 days. PCI is an Equal Opportunity Employer committed to Diversity and Inclusion.  

Hit Submit and you will be returned to our website.
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Sorry, if you don't agree to the Policy, you cannot use this application.
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