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 ( PDF )

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 )

C&O Flow Back Bid Form ( PDF )

Disability Claim - Supplemental Sickness Benefit Plan ( PDF )

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

Extension of Benefits (Updated 01-12-2021) ( 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 12-15-2020) ( 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  )