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Such immunity shall be in addition to and not in limitation of any other immunity provided by law or any absolute or conditional privileges applicable to such disclosure by the virtue of the circumstances of the applicant s consent thereto. Under Act 168 the wilful failure to respond to or provide the information and records as requested may result in civil penalties and/or professional discipline where applicable. I understand that false statements herein including without limitation any...

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Act 168 Form Sexual Misconduct/Abuse Disclosure Release is a form used to gather information about an applicant's past misconduct or abuse related to sexual behavior.

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