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Brotherhood of Locomotive Engineers and Trainmen

 

Western Railroad Lines General Committee of Adjustment


P. O. Box 49 Etowah, TN  37331-0049

  

Forms

Application for Sickness Benefits Form ( PDF )


Application for Transfer ( PDF )


Application for Unemployment Benefits Form ( PDF )


Attending Physician's Return to Work Report - BLE Form MD-3-RRM ( DOC )


B&O Flowback Bid Form ( PDF )


Beneficiary Form - Railroad Employees National Health and Welfare Beneficiary Designation ( PDF )


BLET Official Application for Membership ( PDF )


BLET-PAC Fund - Donation to the PAC Fund ( PDF )


Certification of Ongoing Illness or Injury ( PDF )


Claims Codes to be used under the 2007 Single System Agreement ( PDF )


CMC Management Problems ( PDF )


Conrail Flowback Bid Form ( PDF )


CSXT Hotel Evaluation Form ( PDF )


Disability Claim - Supplemental Sickness Benefit Plan ( PDF )


Disputes Resolution Committee Fact Sheet  ( PDF ) ( Fillable Form  PDF )


Family Status - Notice of Change in Family Status ( PDF )


Labor Protective Claims - Questionnaire for CSXT Claims of Protective Labor ( DOC )


Lodging Complaints Form ( DOC )


Member's Application for Transfer Card - Transfer Card ( PDF )


Notice of Claim / Grievance (Ble Form R-100) ( PDF )


Personal Business/Personal Leave Denial Form ( PDF )


Proof of Disability (Updated 08-11-2020) ( PDF )


Safety SENSE - Unsafe Condiction/Practice Report ( PDF )


Sickness Benefits - Application for sickness benefits ( PDF )


Statement of Sickness Form ( PDF )


Unemployment Benefits - Application for unemployment benefits ( PDF )


UTU Union Dues Revocation Form ( PDF  )