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CRIMINAL HISTORY ATTESTATION
(Note: It is the policy of the Blackstone Group to review an individual’s criminal history only after we have extended, and you have
accepted, a conditional offer of employment. A conviction record will not necessarily be a bar to employment. Factors such as the
date, nature and seriousness of the offense and your rehabilitation will be taken into consideration.)

Have you ever been convicted of or pleaded guilty to any crime? Do NOT report any arrest or
criminal accusation which was followed by (1) a termination of that criminal action or proceeding in
your favor; (2) a youthful offender adjudication; or (3) a direction that the record be sealed pursuant
to judicial order. Please note that the term “crime” includes any violation, misdemeanor, or felony,
including traffic infractions that are not subject to the foregoing three exclusions.

Yes □ No □
If yes, please explain:

BACKGROUND INFORMATION
Have you ever been subject to any order, judgment, decree or sanction issued by a regulatory
agency, arising out of any banking, securities or investment activities? Yes □ No □

If yes, please explain:

At this time are any administrative or regulatory charges pending against you? Yes □ No □
If yes, please explain:

Dated:

(Signature)

By: (Print Name)