Desiree Robinette

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CERTIFICATION RECORD FORMCERT NO: 484453F

NAME: DESIREE MARIE ROBINETTEPREVIOUS NAME:

DOB: 10/02/1987SEX: F

9/26/2011

CERTIFICATE TYPE: EMERGENCY SUBSTITUTE TEACHERISSUE DATE: 09/26/2011

EXPIRATION DATE: 06/30/2014

FOR USE IN: SEATTLE PUBLIC SCHOOLSRECOMMENDED AGENCY: SPI. OFFICE OF pROFESSIONAL CERTIFICATION1ST ISSUELIMITED TO 30 DAYS OF CONSECUTIVE SERVICE IN ONE ASSIGNMENT

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1 1 0 3 3 4 0---~~--------------------------------------~'!~--~~~--------------'--------------~~~--~OFFICEOFSUPE~:~!~~~I~e~~~~~C INSTRUCTION F(;,;ef~~'fp1__9 . 1 5 ' Q J ~ l .

O ld C a pi to l B u il di ng , P O BOX 4 7; lO OO L Y MP IA W A a S 50 4 + 72 0 0(360) 725-64DO rr v (3$0) ~64-3631We b S H e : h t tp : / /w Iw i .k 1 2 . w a .t J slc er ti f ic a t ia n JE-Mail: oer [email protected] FOR WASHINGTON STATEEMERGENCY SUBSTITUTE CERTIFICATION

Certificate is valid for three years or Jess,Please complete the following questions and sign the affidavit.1, NAME MIDDLE NAME

2, ADDRESS

CITYISTATEIZIP(),1 L Q5. TeLEPHONE:BUSINESS ( HOME'

7. Have you ever held a Washington teacher, administrator, or eduGational staff associate certificate?If yes, whatwas your certificate numbe . 7. 0 YES [ 2 1 ' NO8. Have you held aneducational cert if icate inanother s late? Ifyes, l is t a ll such states here and complete 8. 0 YES m : NO

F"" S~CDU 4020C I I9. List the name of filJety community college and undergraduate instUution you have attended in the space below and provide the additionalinformation requested_Official transcripts (thosewith the college Of university seal) must be submitted and attached to this page of your

Dates Atten ded Degrees Post BA Credits Earned TranscriptInstitution Location City/State From To Granted Semester Quarter EnclosedUhtY tk Situ d - t " J t . U \ \ l \ ' 1 ! 1 I D ( J ~U\lt\t: IW v t ~~l'r, ~\'lVU- B"A";0(1\ ... - u > t c >

-

..Attach separate pagefor additional education. if necessary.

For use by Professional Certif ication Only M a l l e S E P 2 7 2 0 1 1Issued;,e-

FORM SPI/CERT 4027 A (Rev. 1 /11 ) Page 1, "'" ' ..... " , . " . , . ]
mailto:[email protected]:[email protected]


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10. Official t ranscripts (those with the college or university seal) must be submitted and at tached to this page of your application. List all transcriptsyou are providing.

11. Provide your employment history for the past ten years.EDUCATIONAL EXPERIENCE Please list your most recent experience f irst:I Z I 1have hot been employed i n an educat ional setting in the past ten years.Grades Dales of Dlslrkt City/Slole No,ofDaystf,a"phl Elno)oYm~nt l es s ' th a n F uU - Ti m e T yp e o f Certificate Hold

ATTACH ADDITIONAL SHEE.TS IF NECESSARY.NON-EDUCATIONAL EXPERIEMCEo I have not been employed in a non-educational sett ing in the past ten years.

ATTACH ADDITIONAL SHEETS IF NECESSARY.

NOTE: ALL OFFICIAL TRANSCRIPTS NEEDED TO EVALl:JATE YOUR APPLICATION FOR A CERTIFICATE MUSTBE SUBMITTED WITH THIS APPLICATION.

AFFIDAVITI,D (IS 'V U ItiJ V \Y\J.. tf.t , certify (or declare) under penalty of perjury under the laws ofthe State of Washington that theforego ing and al l in format ion inc luded In this. appl icat ion is t rue and correct. tf Ihe answers to any question on the application or the characterand f it ness supplement change prior to my beIng granted cert if ication, I must immediately not if y Professional Cert ification at OSPI.~t~ttt?Biqnature Date CHyISt.l.

THIS FORM MUST BE INCLUDED IN THE APPLICATION PACKET. ATTACH YOUR CHECK TO THIS FORM.APPLICATIONS RECEIVED THAT DO NOT INCLUDE ALL OFTHE REQUESTED MATERIALS WILL BE RETURNED TaTHEAPPLICANT.

FORM SPIiCERT 4027A (Rev, 1/11) Page 2


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oFFIcE O F S UP ER I NTE NO EN T O f P UB LIC IN STR UC TIO NP r o fe l on n l C q rt il ic a U ono m c e 0 1 P r o fe ss io na l P r ac ti ce s

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Yes NoD [/j 10.D ijf 11.

Have you eVer been discipl ined by a past or present employer because of allegations of misconduct?Are you currently or have you ever been the subject of any investigat ion or inquiry by an employer because ofallegations of misconduct?

s$crlON.HI- C R I M I N A L HISTORY : ' :' " . . .' '.. '. '. .' ,. . " :- c- -. c ol- I- 'E :JW :J :::l a,z I- a > L L .C i5 0)i= ~ Ow0 (I) .2:- "0 I-a::0:: III c :: 2 - ZFW w:J 0 > - w - ~ ill a 0 z!2c:( ~ a w WID~ wO III 0 ..c [) t-oQ)W ~ffi :2 w o Z ;?; gj '~LU >...... (I) illW Q(9 if} f = " ' - (ll :2 0:::a::C!)..-n :: ~ n : : : o c 00 B :2 WOroOw- t(W w:! o . . I " U ~:200 0 LL(O c s 0 :Jf-c(O

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