2012 ACKNOWLEDGEMENT OF TRAINING FORM

NOTE: This form may be completed by typing on it or completed manually after printing a blank form. Completed and signed forms may be submitted via FAX or sent electronically via email.

I CONFIRM I COMPLETED THE 2012 EMERSON ETHICS REFRESHER TRAINING ON: ______(DATE)

THIS TRAINING WAS PRESENTED BY:

ELECTRONIC ADOBE CONNECT PRESENTATION

______

SIGNATURE: ______

PRINT YOUR NAME: ______

YOUR EMPLOYEE ID NUMBER: ______

YOUR BUSINESS UNIT & LOCATION (Please check one only):

  PSS Austin /   PSS MidWest Engineering Center
  LLLP Austin, TX /   PSS Calgary
  PSS West Coast Engineering Center /   PSS Marshalltown, Iowa
  Bradenton, FL /   PSS GCEC and Houston, TX
  PSS Philadelphia
  PSS other USA location not listed: ______
  PSS in Asia Pacific world area: ______/   PSS Leicester UK
  MHM
  AO-EP /   PSS Costa Rica
  Other unit & location not listed: ______

Send completed form to your local or business unit HR or training coordinator as follows:

IF your Emerson Process Management work location or work unit is: / Then fax (or email) completed form to:
Austin and Philadelphia / Meghan Anton, (512) 834-7070
PSS St. Louis and Kansas City / MaryKay Walther, (314) 872-6051
PSS Calgary / PSS Calgary HR Dept., 403-258-6226
PSS in Marshalltown, Iowa / Meghan Anton, (512) 834-7070
PSS Bradenton, Florida / Crystal Doubleday, (941) 744-0314
GCEC Houston TX / Heather Fox, (281) 988-4451
West Coast Engineering Center / Debbie LeBlanc, (888) 510-3812
MHM / Pamela Chips, (865) 218-1493
AO-EP / Lou Wack, (953) 828-3279
PSS other USA location / Meghan Anton, (512) 834-7070
Other non-USA location / HR Manager providing support to your unit