The document appears to be an application for the Indian Army's University Entry Scheme for engineering students, as it requests personal details, education history, marks obtained, and a declaration agreeing to terms of service if accepted into the program. It provides instructions for candidates to fill out the form, submit documents, and notes the selection process may involve shortlisting and minimum marks cut-offs.

1. INDIAN ARMY
Additional Directorate General of Recruiting
APPLICATION FORM
UNIVERSITY ENTRY SCHEME-23 (Commencing July 2014) Paste passport
size photo duly
attested by
Note: - Only Male candidates studying in Pre Final Year of Engg can apply for
University Entry Scheme (UES)-23. 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) 4.Marital Status :
(As given in Matriculation Certificate) Married/Unmarried
5. Father’s Name (As given in Matriculation Certificate):
6. Mother’s 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): Yes No
Entry SSB/Location 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 :
Page 1/3

2. 12. Marks/Grade Obtained (whichever applicable)
nd
(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
Total Marks %age per university based on CGPA
Marks Scored rules
1st Semester
2nd Semester/1st Year
3rd Semester
4th Semester/2nd Year
5th Semester
(Architecture only)
6th Semester/3rd Year
(Architecture only)
% 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. Marks Obtained in 12th Class (PCM) : Subject Total Marks Marks Obtained
14. List of Enclosures:- Physics
(a) Chemistry
(b)
Maths
(c)
(d) % 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: Signature of Applicant
Page 2/3

3. 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 :____________________ Signature_______________________
Date :____________________ Office Stamp Designation ____________________
Note : Certificate signed by Heads of Departments will not be acceptable.
Page 3/3