Form Gbrig 5 PDF Details

In the landscape of educational employment and familial responsibilities, the GBRIG-5 form emerges as a pivotal document for employees within the Cobb County School District. This specific form functions under the parameters of the Family and Medical Leave Act (FMLA), specifically addressing the Military Caregiver Leave provisions. It allows a covered service member to officially designate an employee of the Cobb County School District as their Next of Kin for purposes of military caregiver leave. The form is meticulously structured in two primary sections: one to be completed by the covered service member, which includes their affirmation and details, and the other by the designated employee, which asserts their relationship to the service member and their commitment to providing care. This process necessitates a formal certification by both parties highlighting their relationship, contact information, and a notarization to underscore its authenticity. Through this, it ensures that employees who are taking on the noble and challenging role of a caregiver to a service member can do so with the full support and acknowledgment of their employer, emphasizing the community’s dedication to learning and supporting one another in times of need. As such, the GBRIG-5 form is an essential tool in bridging the gap between employment obligations and family commitments, paving the way for a supportive work environment.

QuestionAnswer
Form NameForm Gbrig 5
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesmilitary next of kin document, military replacement form, Marietta, military next of kin form

Form Preview Example

Cobb County School District

Form GBRIG-5

A community with a passion for learning!

FMLA MILITARY CAREGIVER

NEXT OF KIN VERIFICATION FORM

TO BE COM PLETED BY COV ERED SERV I CE M EM BER:

I , _____________________________ , do designat e ______

____________________________ ,

( Full Nam e of Cov er ed Ser v ice Mem ber - Please Pr int )

 

( Nam e of Em ploy ee- Please Pr int )

an em ploy ee of t he Cobb Count y School Dist r ict , as m y Nex t of Kin under t he Milit ar y Car egiv er Leav e pr ov isions of t he Fam ily and Medical Leav e Act .

Relat ionship t o Em ploy ee

______________________________________

Signat ur e of Cov er ed Ser v ice Mem ber

Addr ess of Cov er ed Ser v ice Mem ber

 

 

 

 

 

 

 

 

Wor k Phone

Hom e Phone

Cell Phone

______________________________________

 

 

Dat e

 

 

 

Not ar y

TO BE COM PLETED BY EM PLOYEE:

I , ___________________________________ , ( dat e of bir t h

 

) do her eby cer t ify t hat I am t he designat ed

( Full Nam e of Em ploy ee- Please Pr int )

 

 

Nex t of Kin t o pr ov ide car e under t he Milit ar y Car egiv er Leav e pr ov isions of t he Fam ily and Medical Leav e Act t o

___________________________________ .

( Nam e of Cov er ed Ser v ice Mem ber - Please Pr int )

_____________________________________

Relat ionship t o Cov er ed Ser v ice Mem ber

______________________________________

Signat ur e of Em ploy ee

Addr ess of Em ploy ee

Wor k Phone

Hom e Phone

Cell Phone

______________________________________

 

Dat e

 

 

 

Ple a se m a il com ple t e d f or m t o:

 

Cobb Cou n t y Sch ool D ist r ict , Be n e fit s Office

 

5 1 4 Glov e r St r e e t

M a r ie t t a , Ge or g ia 3 0 0 6 0

 

Or Fa x t o: ( 7 7 0 ) 4 2 9 - 5 8 0 9 – Fa x

8/ 12/ 09

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The right way to fill out military next of kin part 1

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I dat e of bir t h Full Nam e, Or Fa x t o Fa x, and Ple a se m a il com ple t e d for of military next of kin

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