1/3

CENTRE FOR PERSONNEL TALENT MANAGEMENT (CEPTAM) DEFENCE RESEARCH & DEVELOPMENT ORGANISATION (DRDO) MINISTRY OF DEFENCE, GOVT OF INDIA
Application Form [CEPTAM - 06] DRDO ENTRY TEST - 2013

Application No.

00113543444

SMS Registration No. Post

090113017686 0113-STA 'B' (Electronics) Preference 1 : 09 - Delhi NCR

Preference for Exam City

Preference 2 : 01 - Agra Preference 3 : 06 - Chandigarh

A. Personal Details

Candidate's Name as recorded in X Class Certificate (Leave one blank space between parts of the name) Father's/ Mother's/ Husband's Name Leave one blank space between parts of the name (Do not use Mr/Mrs/Sh/Smt etc) Gender Date of Birth Category Are You an Ex-Service Man (ESM) Are You a Govt. Servant (GS) Are You a Meritorious Sports Person(MSP) Are You a Widow / Divorce Are You Physically Disabled Nationality

BHUPENDRA SINGH ADHIKARI

MAHESHWAR SINGH ADHIKARI

male 21/02/1990 Unreserved(UR) No No No No No Indian

B. Communication Details [All particulars given below should be maintained active till the end of selection process]

Address1 *

POCKET C-55 LIG FLATS

2/3
Address2 Address3 Address for Correspondence City * State * Pincode * Country * Address1 * Address2 Address3 Permanent Address City * State * Pincode * Country * Email ID: STD Code Phone Number Mobile No. mail4bsa@gmail.com +91 9582217235 DDA GTB ENCLAVE NAND NAGRI DELHI DELHI 110093 India H-NO 20, STRET NO-17B KAUSHIK ENCLAVE BURARI DELHI DELHI 110084 India

C. Educational Qualifications

Main Subjects/Trade Exam (Specify subject/trade as mentioned on the certificate/degree of EQR) ENGLISH SCIENCE HINDI MATHEMATICS SOCIAL SCIENCE ALL SUBJECT IN ELECTRONICS ENGINEERING. BOARD OF TECHNICAL EDUCATION DELHI 07-2009 3 University/Board Year of Passing Duration of Course(in Years)

Marks Obtained & Maximum Marks(eg. 238/500)

% of Marks Secured

CBSE

05-2005

350/500

70.00

Diploma

4667/6550

71.25

Specify Subject/Trade as mentioned on certificate/diploma/degree of EQR DIGITAL ELECTRONICS AND MICROPROCESSOR SYSTEM AND DESIGN Exempted (SC/ST/ESM/PWD/WOMEN Etc) Payment Mode If Online, details of Online Amount 50 No ONLINE

Employment Record in Govt./PSU/Autonomous Body etc (if any) ? (Forward application through proper channel with advance copy before closing date) *

No

D. Important Endorsements

(a) (i) Mention Photo Identify Proof details (PAN Card/ Voter Id/Passport/College Id/ Aadhaar/ Govt Id card)

3/3
(Attach Copy). The Same is to be produced during the entire process of recruitment (Driving License is not a valid Id Proof). Type of Proof No. (ii) For the Post of STA 'B' & Technician 'A' Only (fill up as applicable) Are you pursuing M.Sc./B.E./B.Tech Degree/ Ph.D: No VOTER ID AZK2458106

Any other relevant information /Specific requirements by VI candidates, if any I hereby declare that :

a. I have read and understood all the provisions mentioned in the advertisement and undertake to abide by them. b. All the statements made in this application are true, complete, and correct to the best of my knowledge and belief, and have filled it in my own handwriting. c. I have submitted only one application for one Post in response to this advertisement. d. I understand that in the event of any information being found suppressed, false or incorrect or any ineligibility being detected before or after the examination/selection, my candidature/selection/ appoinment is liable to be cancelled. Please tick mark ( ) the following CHECK LIST:

a. Application form duly signed on both pages and coloured photograph(with Name and date of photo) pasted. b. Proof of Age(i.e. self attested copy of X-Class Certificate) attached c. Self Attested Copies of EQR Certificates attached d. Self Attested Copies of Driving License attached (For Civillian Driver 'A' and Fire Engine Driver 'A' only) e. Copy of ID Proof(as per details filled in application form) attached (NO ENTRY IN EXAMINATION CENTRE WITHOUT ID PROOF). f. IPO for examination fee, if applicable attached. g. Self Attested Copies of SC/ST/OBC/PWD/ESM etc if claimed, certificates attached. h. Self addressed stamped post card (indicating post code, post name & subject) for acknowledgment at the end of all enclosures attached

Left Hand Thumb Impression of Candidate

Signature of Candidate

Copyright 2013, CEPTAM, DRDO. All rights reserved.