....since 1954

Harrisonburg and Purcellville, Virginia Terminals

 Loudoun Milk Transportation, Inc.

 

 

Food Grade Bulk   Liquid Transport 

 

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Employment Application

Loudoun Milk Transportation is committed to providing equal opportunity employment opportunities to candidates and employees without regard to race, religion, creed, age, sex, height, weight, marital status, disability unrelated to an individualís ability to perform adequately, national origin citizenship, ancestry, or any other characteristic protected by law.
 

All Information you submit is sent via encryption through our secure web server and held at our office confidentially under lock and key. Information on Applicants that are not hired at this time will be destroyed after six months.

Personal Information    
  Title of Position You Are Applying For :
 
 
First Name:
     
Middle Name:
     
Last Name:
     
 
  Address:
 
 
City:
     
State:
     
Zip Code:
      
 
 
Home Phone:
     
Cell Phone
     
Fax (optional)
     
 
 
Social Security Number:
        
E-mail Address:
     
 
  Best time to contact you within 5 Days of posting
 
 
Driver License Information  
 
License Number:
     
State Issued:
     
Expires:
 
Date of Birth:
 
  Years Verifiable Tractor Trailer Experience:
 
Endorsements
Please check all the boxes pertaining to your license.:
  What Is Your Current CDL License Class: A B C

None

  Do You Have A Tanker Endorsement:    YES NO
 
Safety Record  
  Have You Had Any Accidents In The Last 3 Years?:  YES NO
  Have You Had Any Tickets In The Last 3 Years?:  YES NO
  Have You Had A DWI or DUI?:  YES NO
  Have You Ever Been Convicted Of A Felony?:  YES NO
  Have You Ever Had Your License Revoked or Suspended?:  YES NO
If the answer to ANY question is yes, state details, circumstances, and date:
 
 
Employment History  
  Present Employer: 
  Company Name:
  Address:
 
City:
     
      State:      
          
       Zip Code:
            
  Phone:
 
Position Held:
     
Employment Dates:

From:       To:
      

Previous Employer  
  Previous Employer 1: List Most Recent Previous Employer First 

 

  Company Name:
  Address:
 
City:
     
State:     
            
Zip Code:
     
  Phone:
 
Position Held:


      

Employment Dates:

From:   To:

 
Previous Employer  
  Previous Employer 2: 
  Company Name:
  Address:
 
City:
     
State:      
     Zip Code:
    
     
  Phone:
 
Position Held:
      
Employment Dates:

From:       To:

 
Comments: Please indicate here the employment position for which you are applying, whether you would like to work full-time or part-time for us, and any additional restrictions or comments you would like to submit.
   

 

 

 
I Have Read The Disclaimer Below And Authorize  A Background Check

 

 

       Yes             No

DISCLAIMER

     Copyright 2007. Loudoun Milk Transportation, Inc. All Rights Reserved.