COOPERSTANDARD

EMPLOYMENT APPLICATION

Name: E-Mail:

LastFirstMiddle

CurrentAddress: Street City State ZipCode

HomeTelephoneNo.: OtherTelephoneNo.:

HaveyoueverbeenemployedbyCooperStandardAutomotive?□Yes□No

Ifyes,pleaseindicatedatesandposition:

Doyouhavework,educationorlicensurerecordsunderanothername?□Yes□No

Ifyes,pleaseindicate:

DoyouhaveanyrelativesemployedbyCooperStandardAutomotive?□Yes□No

Ifyes,pleaseindicate:

Howwereyoureferred?□Employee□Ad□Other

Positiondesired:

SalaryExpectations:

Typeofemployment: / □Full-time □TemporaryFull-time / □CollegeWorkProgram
□Part-time □TemporaryPart-time / □Other

DateAvailabletobeginwork:

Hoursand/orShiftDesired:

Wouldyouworkanyshift?□Yes□NoPercentoftimewillingtotravel: %

Towhatextentareyouwillingtorelocate?

Canyouperformalloftheessentialjobfunctionsoftheposition(s)forwhichyouareapplying,withorwithout reasonableaccommodations? □Yes □No

AreyouacitizenoftheUnitedStatesordoyouhavethelegalrighttobeemployedindefinitelyintheU.S.?

□Yes□No

Haveyoueverbeenconvictedofacriminaloffensethathasnotbeenexpunged,sealedorpardoned?

□Yes□No

Ifyes,charge/date:

Arethereanychargespendingagainstyou?□Yes□No

Ifyes,charge/date:

Acriminalconvictionwillnotnecessarilybaryoufromemployment.Tohelpusevaluateyourapplication pleasedescribethenatureoftheoffense(s)forwhichyouwereconvicted,thecircumstancessurrounding thecommissionoftheoffenseandyoursubsequentrehabilitation.

U.S.Employment--AllStates

Application Rev-7.8.13

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DISCLAIMER:NOTHINGINTHISDOCUMENTISINTENDEDTOCREATEACONTRACTOFCONTINUEDEMPLOYMENT.ASACONDITIONOFCONSIDERATIONFOREMPLOYMENTOROFEMPLOYMENT,APPLICANTAGREESTOACCEPTANDBEBOUNDBYTHETERMSOFTHE“AT-WILL”EMPLOYMENTRELATIONSHIPANDTIMELIMITFORCLAIMSSETFORTHONPAGE5.

RecordofEducation:

NameofSchool
City,State / DatesAttended
From:To: / Major / Graduate
(Y/N) / Dateof Graduation (MO/YR) / Degree
HighSchool/GED:
College:
Graduate:
Businessor
Tradeschool:
Other:

Professionallicensure,registrationorcertification:

State / Type / Number

EmploymentHistory:

If employed,maywecontactyourpresentemployer?□Yes□No

Ifno,pleaseexplain:

Listbeginningwithyourcurrentor mostrecentemployer:

Employer/Organization / LastSupervisor / YourPosition / ReasonforLeaving
(BeSpecific)
CurrentorMostRecentEmployer:
Name: / Name: / JobTitle:
Address: / Duties:
Title:
TypeofBusiness:
Dates:
From: / To: / Phone: / BaseSalary:$
Bonus:
Misc:

U.S.EmploymentApplicationAllStates

Rev-7.8.13

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Employer/Organization / Last
Supervisor / Your
Position / Reasons for
Leaving
PreviousEmployer:
Name: / Name: / JobTitle:
Address: / Duties:
Title:
TypeofBusiness:
Dates:
From: / To: / Phone: / BaseSalary:$
Bonus:
Misc:
PreviousEmployer:
Name: / Name: / JobTitle:
Address: / Duties:
Title:
TypeofBusiness:
Dates:
From: / To: / Phone: / BaseSalary:$
Bonus:
Misc:

Haveyoueverbeendischargedorsuspendedfromemploymentoraskedtoresignyouremployment?□Yes□No

Ifyes,explain:

HaveyousignedaNon-Compete,Non-Solicitation,Confidentiality,orotheragreementwithacurrentorprioremployer thathasrestrictivecovenants? □Yes □No

If yes,pleaseprovidethedate(s)oftheagreement(s)andwithwhomyouenteredintoeachagreement.

Pleaseprovidea copyofeachagreement.

U.S.EmploymentApplicationAllStates

Rev-7.8.13

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RELEASE & WAIVER

Inreturnforbeingconsideredforaposition,Iagreeasfollows:

Iaffirmthatthefactssetforthabovearetrueandcompletetothebestofmyknowledge.Falsestatementsor omissionsinthisapplicationmayresultinarefusaltohire,revocationofanofferofemployment,or terminationofemploymentwhenevertheymaybecomeknown.

I authorizeCooperStandardAutomotiveoritsrepresentativetoinvestigatethoroughlymyeducation,work andprofessionalhistoryandverifyalldataprovided. IreleaseCooperStandardAutomotivefromany liability,whichmightarisefromsuchaninvestigation.Iherebyreleaseanyemployerfromanyobligationto providemewithwrittennotificationofanyinformationdisclosed.Iunderstandthatthismayincludearecord ofdisciplinaryactionassessedbytheemployer.Iunderstandthatemploymentarisingoutofthisapplicationis contingentupontheresultsofthisinvestigation.

IfurtherunderstandthatCooperStandardAutomotiverequiresabackgroundcheck,andthathiringis contingentuponreceiptofsatisfactoryresults.

IunderstandthatifIamofferedemployment,Iwillberequiredtoprovidesatisfactoryproofofidentityand legalworkauthorization;andthatfailuretosubmitsuchproofshallresultindenialofemployment.

Iunderstandthatemploymentmaybebasedonthesuccessfulpassingofjob-relatedphysicalexaminations.

Asaconditionofapplicationforemploymentandforemployment,ifemployed,Iagreenottofile any action, suit or charges relating to my employmentor applicationfor employmentwithCooper Standard Automotivemorethan180days(orinlesstimeifanyapplicable lawsorequires)aftertheevent and/oremployment practiceoractioncomplained ofandIagreetowaiveanystateorfederalstatutesof limitationtothecontrary(exceptthoserequiringashorterperiod),totheextentpermittedbyapplicablelaw. WhileIunderstandthatthestatuteoflimitationsforclaimsarisingoutofanemployment actionmaybe longerthan180calendardays,Iagreeandunderstandthatanyemployeractionthatisthesubject ofa lawsuitoraction,includingthoserelatedtodiscrimination, benefits,terminationofemployment,orother termsorconditionsofemployment,isbarredifitisnotfiledwithinthe180dayperiod(orinlesstimeifany applicablelawsorequires)andIunderstandand agreethatthe180dayperiod(orapplicableshorter period)willnotbeextendedforanyreason,includingcontinuingviolationsandemployeeagrees towaive theapplicationofcontinuingviolationsdoctrines. Thisprovisiondoesnotprohibitthetimelyfilingofa chargeofdiscriminationunderfederal orstatelawwithanadministrativeagency andtheagency’srightto investigateismaintained. However,filingachargeorclaimwithanadministrativeagency,including theEEOCorinternallywiththeCompany,doesnottoll(holdinabeyance)the180calendardayperiod formyfilingofa civilsuitandifIwishtoobtainindividualrelief,Iunderstandthatanylawsuitmustbefiled within180daysofthecomplainedofaction.

U.S.EmploymentApplication-AllStates

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IagreethatifIamemployedbyCooperStandardAutomotive, theemployment relationshipis“at-will” whichmeansthateitherCooperStandardAutomotive orImayterminatetheemployment relationshipat anytimewithorwithoutcauseornotice.

Nootherpractice,procedure, writtenororalpolicyorstatement byanyone,including othermanagement personnel,canalterthe“at-will”employmentrelationship.Whilethe“at-will”employmentrelationshipcan onlybemodifiedassetforthabove,IrecognizethatifIamemployedbyCooperStandardAutomotive,Iwill receivecompensationandbenefitsandbesubjecttorulesandregulations;butIagreethatsuchcompensation, benefits,rulesandregulationsaresubjecttochangebyCooperStandardAutomotivewithorwithoutnoticeto me. Iacknowledgethatmyassignedworkhoursandplaceofworkmaybemodified byCooperStandard Automotive.

Iunderstandthatifemployed,ImaybeaskedandagreetosignaNon-Competition,Non-Solicitationand ConfidentialityAgreementorotheragreementwithrestrictivecovenants.Ialsounderstandandagreethatmy employmentwillbesubjecttoemploymentpoliciesthatCooperStandardAutomotiveadopts.

I haveread,understand,andagreetotheabovestatementsandconditionsof employment.

Signature: Date:

ItisthepolicyofCooperStandardAutomotivenottodiscriminateinitsemploymentandpersonnelpracticesbecause ofaperson’srace,color,religion,sex,nationalorigin,age,disability,oranyotherbasisprotectedbyfederal,state,or otherapplicablelaw.

.

U.S.EmploymentApplicationAllStates

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