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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.

00211112500

SMS Registration No. Post

080211003266 0211-TECH 'A' (Fitter) Preference 1 : 08 - Dehradun

Preference for Exam City

Preference 2 : 09 - Delhi NCR Preference 3 : 01 - Agra

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

TARUN KUMAR

MAHENDRA SINGH

male 02/04/1990 Scheduled Caste(SC) No No No No No Indian

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

Address1 *

VILL-GADHARONA

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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. POST-LANDHORA ROORKEE ROORKEE UTTARAKHAND 247664 India VILL-GADHARONA POST-LANDHORA ROORKEE ROORKEE UTTARAKHAND 247664 India

pintu0742@gmail.com 01332 251602 +91 9990787234

C. Educational Qualifications

Main Subjects/Trade Exam (Specify subject/trade as mentioned on the certificate/degree of EQR) X XII ITI science commerse national itc bongla haridwar uk board uk board uk board 06-2006 06-2008 07-2012 1 1 2 University/Board Year of Passing Duration of Course(in Years)

Marks Obtained & Maximum Marks(eg. 238/500) 253 263 545

% of Marks Secured 42.16 52.60 77.85

Specify Subject/Trade as mentioned on certificate/diploma/degree of EQR fitter Exempted (SC/ST/ESM/PWD/WOMEN Etc) Employment Record in Govt./PSU/Autonomous Body etc (if any) ? (Forward application through proper channel with advance copy before closing date) * No Yes

D. Important Endorsements

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

(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 pan card CXQPK1187b

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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.