Additional Directorate General of Recruiting
UES-22 (PFY) (Commencing July 2013)/ TGC -115 (Commencing in Jul 2012) / SSC (Tech) -39/SSCW(T)-10 (Commencing in Oct 2012) Select your Gender : Male Female
Paste passport size photo duly attested by Gazetted Officer

Course University Entry Scheme-22 Technical Graduate Course (TGC)-115 Short Service Commission (Tech) -39 Short Service Commission Women (Tech)-10 Note :- Pre Final Year Candidates can only apply for UES-22. Candidates applying for SSC (Tech) as first choice cannot opt for TGC as second choice. However, candidates applying for TGC as first choice will automatically be considered for SSC (Tech) as second choice. Personal Details

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

2. Nationality : (Please Tick)




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

4.Marital Status : Married/Unmarried

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):
Entry SSB/Location



11. (a) Educational Qualification : Engg Graduate (B.E./B.Tech./M.Tech) (b) Branch/Stream of Engineering (c) Date of Joining Engineering College: ___________________________________________________ (d) Date of completion of degree/Completion of final exam ;____________________________________ (e) College Name :____________________________________________________________________ (f) University Name :__________________________________________________________________ (g) State in which University Located
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SIGNATURE Page 2/3 . need to convert Grades into %age of marks scored. No representation will be entertained in this aspect. Certificates : (a) (b) (c) Note 1. 13. It may be noted that depending upon the total number of applications received by this office for UES-22/TGC-115/SSC (T)39/SSC W(T)-10 course. paste his / her photograph attested by a Gazetted Officer in the space provided. Any wrong details filled in above application will lead to cancellation of the candidature and suitable action will be taken against the candidate. Candidates are requested to fill the form. Recruiting Directorate reserves the right to shortlist and to fix cut off percentage of marks for SSB 2. Marks/Grade Obtained (whichever applicable) Semester/Year %age of marks scored (If applicable) Total Marks %age Marks Scored Cumulative %age of marks scored Total Marks Cumulative Marks Scored %age SGPA (If applicable) CGPA /DGPA %age of Marks based on Cumulative Grade/ DGPA 1st Semester 2nd Semester/1st Year 3rd Semester 4th Semester/2nd Year 5th Semester 6th Semester/3rd Year 7th Semester 8th Semester/4th Year 9th Semester (Architecture only) 10th Semester/5th Year (Architecture only) Note :. 3. Applying second time on line or by post for TGC-115/SSC (T)-39/SSC W(T)-10 course will lead to cancellation of candidature. 4.12. failing which the application will be rejected. interview. 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. Filling of cumulative %age of marks scored based on the Cumulative Grade at the end of third year/seventh semester/fourth year (as applicable) is compulsory.The universities which have ‘Grade Point’ system. I have read and understood the instructions and undertake to abide by the Terms and Conditions.

I have read and understood the instructions and undertake to abide by them. I undertake to be debarred & my candidature be cancelled. cost of training will be paid by me 14. Certified that Shri ________________________________________S/o __________________________________ Date of Birth_______________________ is studying 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. IMA or OTA or any service training academy on disciplinary grounds. I have never been withdrawn from NDA. (Applicable only for TGC/UES Entry). 9. 8. 4. 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. 2. 13. from TGC/UES to SSC (T). I hereby declare that all statements made in the application are correct and true. my ineligibility is detected and my candidature is cancelled as a result thereof. I also understand that in case of my final selection. This is the only application submitted for UES-22/TGC-115/SSC (T)-39/SSC W(T)-10 course and any duplicate application if detected at any stage. Place :____________________ Date :____________________ Seal Signature_______________________ Designation ____________________ Note : Certificate signed by Heads of Departments will not be acceptable. 5. 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. . Page 3/3 .e. In the eventuality of being recommended by SSB I will have no objection to be medically examined by board of Male/Female doctors. I undertake to join any other parallel entry i. subject to availability of vacancies and agree to the terms and conditions of that entry. He/She is likely to complete his/her Engineering Degree before 01 Jul 2012 for TGC-115/SSC(T)-39/SSC W(T)-10 and 01 Jul 2013 for UES-22 course. This application is accepted provisionally subject to meeting eligibility criteria. if at any stage of selection I indulge in any violation of local orders concerning discipline aspects. 12. provided a lady medical officer is present (applicable only to lady cadets) 10. 3. In case of resignation from Academy. 6. 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. my candidature be cancelled.14. Place: Date: 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. 2. 7. I undertake not to make any claim or compensation if at any stage of selection. I undertake not to marry till I complete the full training at the training academy. in case inducted. 11. my appointment will be provisional subject to satisfactory police and educational verification. Declaration: 1.