Application Form

ONLINE APPLICATION FORM
DRDO ENTRY TEST - 2015
Advt. No. CEPTAM - 08
Cutoff/Closing Date - 8th Feb 2016
For Office Use Only :

ONLINE APPLICATION NUMBER : 80107059459
Printed On Date :24 / 01 / 2016
8. Nationality : INDIAN
9. Willing to serve in Remote Area # : YES
10. Gender :Male [ Y ] Female [ ]
1. POST NAME & CODE

STA'B' -[0107-ELECTRICAL & ELECTRONICS
ENGINEERING]
2. Preference For Exam City
I. 12-HYDERABAD
II. 19-NAGPUR
III. 25-VISAKHAPATNAM
3. Candidate's Name as Recorded in X Class Certificate
SANTHOSH GUDURU
4. Father's Name
SRINIVAS GUDURU
5. Mother's Name
LAXMI GUDURU
6. Date of Birth (as recorded in X Class Certificate)
11 / 04 / 1991 , Age as on Cutoff Date 24Y, 9M, 27D
7. a) Category
[ ]
[ ]
Unreserved (UR)
Scheduled Tribe (ST)
[ ]
[Y]
Scheduled Caste (SC)

Other Backward Class
(OBC)
[ ]
[ ]
Govt. Servant (GS)

Widow/Divorcee
7. b) Sub-Category
[ ]
[ ]
Ex-Service Man (ESM)

Meritorious Sports
Person (MSP)
[ ]
Persons with Disability (PWD)
[ ]
Orthopaedically
Handicapped (OH)
Visually Impaired (VI)
[ ]
[ ]
11. Contact Details (Note : All particulars given below in the

head should be maintained active till the end of recruitment
process)
a ) Address for Correspondence
Name : MR. SANTHOSH GUDURU
C/O : GUDURU SRINIVAS
JAKEER HUSSAIN NAGAR
1-7-203/1/1
SURYAPET
City/State: NALGONDA , TELANGANA
Pincode: 508213 , Landline No:
b ) Permanent Address
Name : MR. SANTHOSH GUDURU
C/O
GUDURU SRINIVAS
JAKEER HUSSAIN NAGAR
1-7-203/1/1
SURYAPET
City/State: NALGONDA , TELANGANA
Pincode: 508213 , Landline No:
c ) Mobile No
+91 - 9703158591
d ) Email
[email protected]
Hearing Impaired (HI)
12. a) Educational Qualifications (Must mention all completed/result awaited/appearing)

Qualification
X
XII
ITI
B.Sc
Diploma
Graduation
PostGrad.
OTHERS1
OTHERS2
Main Subjects / Trade

as mentioned on the
Certificate / Degree of
EQR
NA
EEE
EEE
PEED
University / Board / Roll Year of

No.
Passing
Duration
of Course
(In years)
SSC 0796449
2006
NA
SBTET 06027EE037
JNTUH 09915A0208
JNTUH 12J21D5407
2009
2012
2014
3
3
2
Maximum
Marks /
CGPA
Marks /
CGPA
Obtained
% of Marks
Secured
600
481
80.16
3450
4250
1600
2446
3336
1079
70.91
78.38
67.44
12. b) Higher Qualification [for post of STA 'B' / Tech 'A']

Have you Completed or pursuing M.E/M.TECH/PhD/M.Sc./B.Tech./B.E./AMIE/AMIETE etc.? YES [ Y ] NO [ ]
Institute Name
Qualification
Status
Completion / Likely
Completion Date
JOGINAPALLY B R ENG. COLLEGE
MTECH
COMPLETED
21/11/2014
13. Details of Exam Fee of Rs. 50/- Paid (If not exempted as per Govt. rules)
Payment Method
1162
Fee Amount
50.00
Payment Date
2016-01-24 08:06:02
Payment ID
47755175
Transaction ID Status
126566106
Processed
14. Employment Record in Govt./PSU/Autonomous Body etc. (If any)

Name of Organization
Post Held
Pay Scale /
Grade Pay
Period From Period to

Nature of Duties
(dd/mm/yyyy (dd/mm/yyyy Performed
)
)
15. Important Endorsements

a) (i) Type of ID Proof :
AADHAR CARD
ID No.:
(ii) Height (cm) :
175 (5 Feet 8 Inch)
Weight (kg) :
Identification Mark :
A MOLE ON THE RIGHT HAND LITTLE FINGER
(iii) Driving License : [for post of vehicle operator 'A' only]
(ii ) Two / Three Wheelers:
(i ) LMV :
(i ) HMV :
844576002579
80
(b) For the serving defence personnel only, claiming benefit of Ex-Serviceman
Name of Unit
Rank
Date of
Joining
Date of
Discharge
CO Name
Contact NO.
16. Other relevant information (If any)
17. Declaration
I SANTHOSH GUDURU son/Daughter of SRINIVAS GUDURU 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.
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/recruitment my candidature/recruitment/appointment is liable to be cancelled.
18. Required at the time of document verification/trade test/interview, if shortlisted.
a) Left Hand Thumb Impression
b) Signature of Candidate
Place :
Date :
19. List Of Documents Uploaded

10th Class or Equivalent Certificate , EQR , Caste Certificate
Note : You are NOT REQUIRED to send print out of your application to the CEPTAM/DRDO at this time.
However, it is advised to keep this application form and copy of the advertisement for claiming travel concession from Railways, and also
for future references. CEPTAM does not undertake any scrutiny of application before examination and the eligibility is verified only after
examination. Accordingly, mere allowing the candidates to appear in the examination will not be construed as a ground of being eligible for
the post applied.
# for details, read CEPTAM-08 advertisement
ONLINE APPLICATION NUMBER : 80107059459
, Printed On Date :24 / 01 / 2016

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ONLINE APPLICATION FORM

DRDO ENTRY TEST - 2015

Advt. No. CEPTAM - 08

Cutoff/Closing Date - 8th Feb 2016

For Office Use Only :

1. POST NAME & CODE

Scheduled Caste (SC)

Govt. Servant (GS)

Ex-Service Man (ESM)

Persons with Disability (PWD)

11. Contact Details (Note : All particulars given below in the

Hearing Impaired (HI)

12. a) Educational Qualifications (Must mention all completed/result awaited/appearing)

Main Subjects / Trade

University / Board / Roll Year of

12. b) Higher Qualification [for post of STA 'B' / Tech 'A']

14. Employment Record in Govt./PSU/Autonomous Body etc. (If any)

Period From Period to

15. Important Endorsements

16. Other relevant information (If any)

19. List Of Documents Uploaded

, Printed On Date :24 / 01 / 2016

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