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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.

00111287199

SMS Registration No. Post

030111022230 0111-STA 'B' (Electronics & Communication or Electronics & Telecommunication) Preference 1 : 03 - Bengaluru

Preference for Exam City

Preference 2 : 12 - Hyderabad Preference 3 : 17 - Kochi

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

SANDESH KUMAR

KRISHNARAJA

male 07/05/1987 Other Backward Class(OBC) No No No No No Indian

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

Address1 *

KANAYANA NALLUR POST KARKALA TALUK

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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. udupi KARNATAKA 574122 India udupi KARNATAKA 574122 India KANAYANA NALLUR POST KARKALA TALUK UDUPI DIST KARNATAKA 574122 UDUPI DIST KARNATAKA 574122

sksandesh387@gmail.com 08258 8722608970 +91 9591090776

C. Educational Qualifications

Main Subjects/Trade Exam (Specify subject/trade as mentioned on the certificate/degree of EQR) KARNATAKA SECONDARY X SSLC EDUCATION EXAMINATION BOARD DEPARTMENT OF PRE UNIVERSITY EDUCATION DEPARTMENT OF Diploma ELECTRONICS & COMMUNICATION TECHNICAL EDUCATION BANGALORE Specify Subject/Trade as mentioned on certificate/diploma/degree of EQR ELECTRONICS AND COMMUNICATION Exempted (SC/ST/ESM/PWD/WOMEN Etc) Payment Mode If Offline, details of IPO Name of the Post Office Serial No(s). of IPO SUB POST MASTER BAJEGOLI 33G 870302 No OFFLINE 05-2009 3 03-2003 1 University/Board Year of Passing Duration of Course(in Years)

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

% of Marks Secured

366/625

58.56

XII

PCMB

05-2005

317/600

52.82

3573/4775

74.82

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Date of Issue Amount 21/05/2013 50

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)

(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 PASSPORT H8029818

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.