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(14D)
Online Application Form
Joint CSIR-UGC Test for JRF and Eligibility For Lectureship, NET - 21-12-2014
[Council of Scientic & Industrial Research - HRD Group, Examination Unit]
1. RollNo(To be lled by Oice Only) 2. Application No.
14D693028
3. Applied For : 01 - JRF
4. Subject : 6 - ENG - ENGINEERING SCIENCES
5. Exam Centre : 08 - DEL - DELHI
6. Meduim of NET Exam(As applicable) : 02-ENGLISH
7. Candidate Name : SANDEEP
8. Sex : MALE
9. Father/Mother/Husband Name : FATHER -> DAYANAND
10. Date Of Birth : 06-11-1991
11. Age As On 01-07-2014 : 22 Y, 7 M, 26 D
12. Category : OBC
13. Physically/Visually Handicape(PH/VH) : NA
14. If VH, Do You Want Scribe's Help : NA
15. Write your name and complete Mailing Address.
Name: SANDEEP
Address: SANDEEP S/O MR. DAYANAND
V.P.O KANWALI
TEHSIL- REWARI, DISTRICT-REWARI
City: REWARI
Pin: 123411
State: HARYANA
Signature of Candidate ------>
16. Permanent Address
Name : SANDEEP
Address
: SANDEEP S/O MR. DAYANAND
V.P.O KANWALI
TEHSIL- REWARI, DISTRICT-REWARI City : REWARI Pin : 123411 State : HARYANA
17. Email : sandeeprao245@gmail.com
Note:Bachelors degree holders will not be eligible for Lectureship]
18. Qualifying Degree : B.TECH.
[Candidates enrolled for M.Sc. or having completed 10+2+3 years of qualifying examination as given in column
18, may apply under Result Awaited (RA) category]
19. If Result Awaited : NO
20. Year Of Appearing in Final Exam : NA (If Result Awaited)
21. Give detail of Final Exam Result (If not Result Awaited)
(a) Year Of Passing : 2012 (b) Division : 1ST (c) Mark Obtained (%) : 78.80 %
22. If enrolled in MS-PhD program : NO
(a) Year of enrollment : NA
(b) Year of passing bachelor degree : NA
(c) Division/Grade : NA
(d) Marks Obtained (%) : 0
Application No: 14D693028
23. Specialization :
(a) Specialization Code : 605 (b) Specialization Subject Name : ELECTRONICS AND COMMUNICATION ENGINEERING
24(a) University/Institute Code : 127
(b) University/Institute Name : KURUKSHETRA UNIVERSITY, KURUKSHETRA
DECLARATION
I, SANDEEP, hereby declare that all statements made in this application are true, complete and
correct to the best of my knowledge and belief and in the event of any of the information being found false or incorrect
or any ineligibility being detected before or after the test my candidature is liable to be cancelled and action initiated
against me.
I have submitted only one application for this test.
I further declare that I fulll all conditions of eligibility regarding Age limits, Educational qualications etc. prescribed for
the test.
I also declare that I have never been convicted by any court of law.
I declare that I have gone through the conditions attached to NET and shall abide by the same.
I have enclosed the attested copies of certicate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped), (strike
which is not applicable).
I understand that my application will be rejected summarily if found incomplete/ineligible, and no correspondence will be
entertained by CSIR in this regard.
Date:
Place:
Signature of the Candidate.
ATTESTATION(For 'RA' Category Only)
Not Applicable For You as You have entered RESULT AWAITED as "NO"
25. Challan Detail.
Name of the Bank : INDIAN BANK Branch/City :PITAMPURA
Branch Code : 110019032 Journal No. : 738608
Amount in Figure(Rs.) : 200 Amount in Word(Rs.) : TWO HUNDRED
Challan Date : 31/07/2014 Phone : 9996918245
Signature of Applicant
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
certicate(s) by U.P.C./ordinary Post only, as notied 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 Sr. Controller of
Examination, Examination Unit, Human Resource Development Group, CSIR Complex, Library Avenue, Pusa, New Delhi-
110012 on or before 19-08-2014 (25-08-2014 for remote areas).
Please do not staple the hard copy of the Application form & enclosures.
(Application for Joint CSIR-UGC Test for JRF/LS (NET), December, 2014)
[6 - ENG | 14D693028 | 08 - DEL | 02-ENGLISH]
To,
Sr. Controller of Examinations
Examination Unit, Human Resource Development Group
CSIR Complex,opposite Institute of Hotel Management, Library Avenue
Pusa, New Delhi-110012
Cut and Paste following address on your own envelop(5X11)