Youmustcheckyourregistrationstatuswhenitisnotifiedonourwebsitecsirhrdg.res.

in

(15D)

OnlineApplicationForm
JointCSIRUGCTestforJRF&LS(NET),December,2015
[CouncilofScientific&IndustrialResearchHRDGroup,ExaminationUnit]
1.RollNo(TobefilledbyOfficeOnly)

2.ApplicationNo.

15D738186
15D738186

3.AppliedFor

:02LECTURERSHIP

4.Subject

:3LIFLIFESCIENCES

5.ExamCentre

:06CHECHENNAI

6.MeduimofNETExam(Asapplicable)

:02ENGLISH

7.CandidateName

:CHANDIRAKASANP

8.Sex

:MALE

9.Father/Mother/HusbandName

:FATHER>KPERIYASAMY

10.DateOfBirth

:13021984

11.AgeAsOn01072015

:31Y,4M,19D

12.Category

:SC

13.Physically/VisuallyHandicape(PH/VH)

:NA

14.IfVH,DoYouWantScribe'sHelp

:NA

15.WriteyournameandcompleteMailingAddress.
Name:

CHANDIRAKASANP

Address:

S/OKPERIYASAMY
TPUDAIYURVILLAGE
SIRUMANGALAMPOSTVEPPURTALUK

City:

CUDDALOREDISTRICT

Pin:

606302

State:

TAMILNADU

SignatureofCandidate>

16.PermanentAddress
Name

:CHANDIRAKASANP

Address

:S/OKPERIYASAMY
TPUDAIYURVILLAGE
SIRUMANGALAMPOSTVEPPURTALUKCity:CUDDALOREDISTRICTPin:606302State:TAMILN
ADU

17.Email

:chandruperiyasamy13@gmail.com

Note:BachelorsdegreeholderswillnotbeeligibleforLectureship]
18.QualifyingDegree

:M.SC.

[CandidatesenrolledforM.Sc.orhavingcompleted10+2+3yearsofqualifyingexaminationasgivenincolumn
18,mayapplyunderResultAwaited(RA)category]
19.IfResultAwaited

:NO

20.YearOfAppearinginFinalExam

:NA(IfResultAwaited)

21.GivedetailofFinalExamResult(IfnotResultAwaited)
(a)YearOfPassing:2008(b)Division:FIRSTCLASS(c)MarkObtained(%):73%
22.IfenrolledinMSPhDprogram

:NO

(a)Yearofenrollment

:NA

(b)Yearofpassingbachelordegree

:NA

(c)Division/Grade

:NA

(d)MarksObtained(%)

:0

ApplicationNo:

15D738186

23.Specialization:
(a)SpecializationCode:306(b)SpecializationSubjectName:MICROBIOLOGY
24(a)University/InstituteCode

:028

(b)University/InstituteName

:BHARATHIDASANUNIVERSITY,TIRUCHIRAPPALLI

DECLARATION
I,CHANDIRAKASANP,herebydeclarethatallstatementsmadeinthisapplicationaretrue,completeand
correcttothebestofmyknowledgeandbeliefandintheeventofanyoftheinformationbeingfoundfalseorincorrect
oranyineligibilitybeingdetectedbeforeorafterthetestmycandidatureisliabletobecancelledandactioninitiated
againstme.
Ihavesubmittedonlyoneapplicationforthistest.
IfurtherdeclarethatIfulfillallconditionsofeligibilityregardingAgelimits,Educationalqualificationsetc.prescribedfor
thetest.
IalsodeclarethatIhaveneverbeenconvictedbyanycourtoflaw.
IdeclarethatIhavegonethroughtheconditionsattachedtoNETandshallabidebythesame.
I have enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped), (strike
whichisnotapplicable).
I understand that my application will be rejected summarily if found incomplete/ineligible, and no correspondence will be
entertainedbyCSIRinthisregard.
Date:
Place:
SignatureoftheCandidate.

ATTESTATION(For'RA'CategoryOnly)

NotApplicableForYouasYouhaveenteredRESULTAWAITEDas"NO"

25.ChallanDetail.
NameoftheBank
BranchCode
AmountinFigure(Rs.)
ChallanDate

:INDIANBANK
:00T044
:250
:24/08/2015

Branch/City
JournalNo.
AmountinWord(Rs.)
Phone

:THIRVANMIYUR/CHENNAI
:1851221
:TWOHUNDREDFIFTY
:9994559948

SignatureofApplicant
Note:Please send hard copy of this ONLINE submitted application form duly signed with recent passport size Black & white
photograph along with a copy of original challan (fee deposit receipt) meant for CSIR(Examination Unit) with required
certificate(s) by U.P.C./ordinary Post only, as notified in the Employment News/Website by arranging your own envelop
(5X11) superscribing your subject code, application no., and centre code which should reach to the Deputy Secretary
(Exams),ExaminationUnit,HumanResourceDevelopmentGroup,CSIRComplex,LibraryAvenue,Pusa,NewDelhi110012on
orbefore03092015(10092015forremoteareas).
PleasedonotstaplethehardcopyoftheApplicationform&enclosures.
Note:*******Nochangesintheapplicationformwillbeallowedaftersubmission*****

CutandPastefollowingaddressonyourownenvelop(5X11)

(ApplicationforJointCSIRUGCTestforJRF&LS(NET),December,2015)
[3LIF|15D738186|06CHE|02ENGLISH]

To,
DeputySecretary(Exams)
ExaminationUnit,HumanResourceDevelopmentGroup
CSIRComplex,oppositeInstituteofHotelManagement,LibraryAvenue
Pusa,NewDelhi110012