INDIAN ARMY

Additional Directorate General of Recruiting APPLICATION FORM

UNIVERSITY ENTRY SCHEME-23 (Commencing July 2014) Note: - Only Male candidates studying in Pre Final Year of Engg can apply for University Entry Scheme (UES)-23.
Paste passport size photo duly attested by Gazetted Officer

Personal Details

1. Candidate's Name (As given in Matriculation Certificate)

2. Nationality : (Please Tick)

Indian

Nepalese

Others

3. Date of Birth (dd/mm/yyyy) (As given in Matriculation Certificate) 5. Fathers Name (As given in Matriculation Certificate):

4.Marital Status : Married/Unmarried

6. Mothers Name (As given in Matriculation Certificate):

7. E-mail ID : ___________________________________________8. Mobile No. __________ __________________

9. (a) Address for Communication : __________________________________________________________ _____________________________________________ City/Town:________________________________ District:_________________________ State_____________________________ PIN__________________ (b) Permanent Address :___________________________________________________________________ _____________________________________________ City/Town:________________________________ District:_________________________ State_____________________________ PIN__________________ 10. SSB History : Appeared before in SSB Interview (Please Tick):
Entry SSB/Location

Yes

No
Month/Year

11. (a) Educational Qualification : B.E./B.Tech (b) Branch/Stream of Engineering (c) Date of Joining Engineering College : (d) Date of completion of degree/Completion of final exam: (e) Name of College : (f) Name of University : (g) State in which University Located
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12. Marks/Grade Obtained (whichever applicable)

(Candidate with Diploma in Engineering should enter their aggregated marks of 3 year Diploma on the 2 Semester boxes and enter 00 on the 1st semester boxes). Semester/Year %age of marks scored Cumulative %age CGPA converted Cumulative (If applicable) of marks scored to percentage as %age of Marks per university based on CGPA Total Marks %age rules Marks Scored 1st Semester 2nd Semester/1st Year 3rd Semester 4th Semester/2nd Year 5th Semester (Architecture only) 6th Semester/3rd Year (Architecture only)

nd

% of marks in Diploma final examination (for Lateral Entry Students)

Note :- The universities which have Grade Point system, need to convert Grades into %age of marks scored. Filling of cumulative %age of marks scored based on the Cumulative Grade at the end of First Year/Third/Fourth semester (as applicable) is compulsory; failing which the application will be rejected. Lateral Entry students should enter their Diploma % against the first year % of B.E/B.Tech

13.
14.

Marks Obtained in 12th Class (PCM) :

List of Enclosures:(a) (b) (c) (d)

Subject Physics Chemistry Maths

Total Marks

Marks Obtained

% of Marks

Note 1. Candidates are requested to fill the form, paste his photograph attested by a Gazetted Officer in the space provided, sign it in blue ink in the space provided and sent it along with attested copies of the required certificates to concerned Command HQrs by post as given in the advertisement. 2. It may be noted that depending upon the total number of applications received by this office for UES-23 course, Recruiting Directorate reserves the right to shortlist and to fix cut off percentage of marks for SSB interview. No representation will be entertained in this aspect. 3. Any wrong details filled in above application will lead to cancellation of the candidature and suitable action will be taken against the candidate. 15. Declaration:

1. I have read and understood the instructions and undertake to abide by them. 2. I hereby declare that all statements made in the application are correct and true. 3. I undertake not to have any objections in the event of my final selection on allotment of any Arms/Service in the interest of the organisation. 4. I have never been debarred from appearing in any examination or UPSC and nor have I been arrested or convicted by a criminal court or involved in any other case registered by Police. 5. I undertake not to make any claim or compensation if at any stage of selection, my ineligibility is detected and my candidature is cancelled as a result thereof. 6. This is the only application submitted for UES-23 course and any duplicate application if detected at any stage, my candidature be cancelled. 7. Any misinterpretation and wrong declaration/ concealment of information in the application will render my candidature to be cancelled and I may be debarred from this course. 8. I have never been withdrawn from NDA, IMA or OTA or any service training academy on disciplinary grounds. 9. In the eventuality of being recommended by SSB I will have no objection to be medically examined by board of Male/Female doctors, provided a lady medical officer is present (applicable only to lady cadets) 10. I undertake to be debarred & my candidature be cancelled, if at any stage of selection I indulge in any violation of local orders concerning discipline aspects. 11. I undertake to join any other parallel entry i.e. from UES to SSC (T), subject to availability of vacancies and agree to the terms and conditions of that entry. (Applicable only for UES Entry). 12. I undertake not to marry till I complete the full training at the training academy, in case inducted. I also understand that in case of my final selection, my appointment will be provisional subject to satisfactory police and educational verification. 13. In case of resignation from Academy, cost of training will be paid by me 14. This application is accepted provisionally subject to meeting eligibility criteria.

Place: Date: Page 2/3 Signature of Applicant

CERTIFICATE BY THE VICE CHANCELLOR OR REGISTRAR/DEAN OF CONCERNED FACULTY IN CASE OF UNIVERSITY STUDENTS PRINCIPAL/HEAD OF THE TECHNICAL INSTITUTIONS
1. Certified that Shri ________________________________________S/o ________________________________ Date of Birth_______________________ is presently studying in Pre-Final Year(Semester_______) Branch of Engg _______________________ in this University/College/Institute and that the details furnished in Coloumn 11 and 12 of Application Form have been checked with references to relevant records and found correct. . 2. He is likely to complete his Engineering Degree before 01 Jul 2014.

Place :____________________ Date :____________________ Office Stamp

Signature_______________________ Designation ____________________

Note : Certificate signed by Heads of Departments will not be acceptable.

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