*Division Name:	select All Costruzioni Meccaniche Legnanesi Durst Electra-Gear Foote-Jones GE Comm. Motors by RBC GE Capacitors by RBC Grove Gear Hub City LEESON Canada LEESON Electric Lincoln Motors Marathon Electric Marathon Special Products Mastergear USA Mastergear GmbH Regal-Beloit Corporate Regal Beloit Sinya Richmond Gear Thomson Technology Velvet Drive		Please provide accurate information. Certain required fields (*) should be filled out prior to submission. Thank you. 1) This application will be considered active for 90 days. If you wish to be considered for employment there after, submit another application. 2) Applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, or veteran status. 3) In compliance with our responsible hiring policy, thorough reference checks will be performed on all job candidates prior to an offer of employment. As a condition of employment, all candidates will be required to pass a pre-employment drug screen after an offer of employment is made. 4) Unless otherwise stated in writing by the Chief Executive Officer, all employment with Regal Beloit Corporation will be considered at-will. Under this arrangement either party may end the employment relationship at any time, for any reason. 5) If you are in need of help or reasonable accommodation with this application or anytime during the interview process, please advise us.
*Location:	select Aberdeen, SD Beloit, WI Black River Falls, WI Blytheville, Arkansas Brownsville, TX Capcom, Mexico Casa, Juarez, Mexico Fort Wayne, IN Hyderabad, India Grafton, WI Houston, TX India Indianapolis, IN Langley BC Canada Lebanon, Missouri Liberty, SC Lincoln, Missouri Mississauga, ON Monterrey, Mexico Neillsville, Wisconsin Reynosa, Mexico Shopiere, WI Springfield, MO Union Grove, WI Wausau, WI West Plains, MO
*Last Name:
*First Name:
*Middle Initial:
*Street Address:
*State/Prov:
*City:
*Zip:
*Email:
*Phone:
Cell Ph:

PERSONAL DATA

*Are you able to verify legal eligibility for employment in the USA?	Yes No
If you answered NO, please explain:
*Have you ever been convicted of a crime? (Omit minor traffic violations) NOTE: A conviction record will not necessarily bar applicant from employment.	Yes  No
If you answered YES, please explain:
*Is any additional information relative to change of name, use of assumed name, or nickname necessary to enable a check being made of your work record?	Yes No
If you answered YES, please explain:
*Position Desired
*Salary Requirements
*Are you at least 18 years of age?	Yes No
*How were you referred to Regal Beloit Corporation?
*Are you willing to travel?	Yes No
If you answered YES, what %
*Are you willing to relocate?	Yes No
If you answered YES, any restrictions?
*Date available for employment
*Have you ever applied for work OR worked for this Company or any of its subsidiaries or affiliates before?	Yes No
If you answered YES, which location
Please supply the date of service

EDUCATION & TRAINING

Select highest grade completed in each school category:

* High School	9th 10th 11th 12th
Tech School	1 2
College	1 2 3 4
Grad School	1 2
High School Name:
High School Location:
Diploma, Degree or Certification
Did you graduate?	Yes No
College Name:
College Location:
Diploma, Degree or Certification
Did you graduate?	Yes No
Graduate School Name:
Graduate School Location:
Diploma, Degree or Certification
Did you graduate?	Yes No
Apprentice, Business, Technical, Military or Vocational School Name:
Apprentice, Business, Technical, Military or Vocational School Location:
Diploma, Degree or Certification
Did you graduate?	Yes No

List any special skills or knowledge you possess such as: Computers, CAD, ISO, Languages, Etc.

REFERENCES

Name:		Name:
Address:		Address:
Daytime Phone:		Daytime Phone:
Occupation:		Occupation:
Relationship:		Relationship:
Years Known:		Years Known:

Name:		Name:
Address:		Address:
Daytime Phone:		Daytime Phone:
Occupation:		Occupation:
Relationship:		Relationship:
Years Known:		Years Known:

May we contact your employer?	Yes No

EMPLOYMENT (List present or most recent first)

Dates (Mo. & Yr.)			Salary	Starting Base
From - To			Per year
Employer			Bonus
Name:				Ending Base
Address:			Per year
City and State:			Bonus
Co. Telephone
Supervisor
Title or Position	(Describe Duties)

Specific reason for leaving:

EMPLOYMENT (List present or most recent first)

Dates (Mo. & Yr.)			Salary	Starting Base
From - To			Per year
Employer			Bonus
Name:				Ending Base
Address:			Per year
City and State:			Bonus
Co. Telephone
Supervisor
Title or Position	(Describe Duties)

Specific reason for leaving:

EMPLOYMENT

Dates (Mo. & Yr.)			Salary	Starting Base
From - To			Per year
Employer			Bonus
Name:				Ending Base
Address:			Per year
City and State:			Bonus
Co. Telephone
Supervisor
Title or Position	(Describe Duties)

Specific reason for leaving:

EMPLOYMENT

Dates (Mo. & Yr.)			Salary	Starting Base
From - To			Per year
Employer			Bonus
Name:				Ending Base
Address:			Per year
City and State:			Bonus
Co. Telephone
Supervisor
Title or Position	(Describe Duties)

Specific reason for leaving:

List other forms of compensation or information about your LAST position in the space below:

*Please tell us in your own words what will make you a successful employee:

DISCLOSURE OF PRIOR BUSINESS AGREEMENTS

As part of the hiring process it is important to be aware of any and all previous employment agreements which may impact on your employment with us. Therefore, please indicate if you have ever signed:

• *A non-compete agreement	Yes No
• *Secrecy or invention agreement	Yes No
• *Confidentially agreement	Yes No
• *Patent agreement	Yes No

If the answer to any of these is yes, please tell us about it:

• The nature of the agreement:
• When you signed it:
• With whom was the agreement made:

Should I become an employee of Regal Beloit Corporation or any of its divisions or subsidiaries, I agree, In consideration of such employment, that I will not divulge to others or use for my own benefit any confidential information or trade secrets obtained during the course of my employment relating to sales, formulas, processes, manufacturing methods, machines, compositions, ideas, improvements or inventions belonging to or relating to the affairs of Regal Beloit Corporation. Furthermore, if I accept employment I will comply with all policies related to business conduct and ethical behavior.(By submitting this form you have agreed to the above statement. (By submitting this form you have agreed to the above statement)

I certify that the foregoing information is complete and accurate, and recognize that falsifications or omissions may result in my dismissal, if hired. I authorize Regal Beloit Corporation to act as my agent in securing information about me from any person or company without liability to such person or company or Regal Beloit Corporation. I am further authorizing and requesting all current and previous employers, educational institutions or others who possess information about my suitability for employment to share that information with Regal Beloit Corporation or its agents. This may include: a statement of the reason why I am no longer employed by a specific organization, work performance and abilities, or other pertinent information relative to the position for which I am applying. I agree that, If hired, I will conform to the rules and regulations of Regal Beloit Corporation and further understand and agree that my employment is for no definite period and may, regardless of the time and manner of payment of my wages and salary, be terminated at any time by me or Regal Beloit Corporation, with or without cause, without any previous notice. Further, I understand that no manager or representative of the Company, other than the Chief Executive Officer has any authority to enter into any agreement guaranteeing employment for any specified period of time. I understand that employment with Regal Beloit Corporation is conditional upon a favorable pre-employment drug screen to which I will consent.

(By submitting this form you have agreed to the above statement)

*Today's Date: