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See FORM ADR-1003/GDC/CCC and FORM ADR-1003/JDR/CCF. August 2015 BACKGROUND 1. Have you ever 1 had a disciplinary action related to a profession including mediation for example a professional license suspended or revoked 2 had any professional privileges curtailed and/or 3 relinquished a professional privilege or license while under investigation Yes No If Yes describe on the lines provided below. 2. Have you ever been convicted of a felony a misdemeanor includes reckless and aggressive...
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