Online Application Form

ONLINE APPLICATION FORM
Advt. No. CEPTAM - 07
DRDO ENTRY TEST - 2014
Closing Date - 17th Oct 2014
For Office Use Only :

ONLINE APPLICATION NUMBER : 90106043071
Printed On Date :15 / 10 / 2014
22:51:4
8. Nationality : INDIAN
9. Willing to serve in Remote Area : NO
10. Gender :Male [ Y ] Female [ ]
1. POST CODE
STA'B'-[0106-ELECTRICAL & ELECTRONICS]
2. Preference For Exam City
I. 17-KOCHI
II. 03-BENGALURU
III. 07-CHENNAI
3. Candidate's Name as Recorded in X Class Certificate
ANOOP K
4. Father's Name
DAMODARAN K
5. Mother's Name
PREMAVALLY K
6. Date of Birth (as recorded in X Class Certificate)
14 / 06 / 1991
7. a) Category
[ ]
[ ]
Unreserved (UR)
Scheduled Tribe (ST)
[ ]
[Y]
Scheduled Caste (SC)

Other Backward Class
(OBC)
7. b) Sub-Category
[ ]
[ ]
Ex-Service Man (ESM)

Meritorious Sports
Person (MSP)
[ ]
[ ]
[ ]
Persons with Disability (PWD)
[ ]
Orthopaedically
Handicapped (OH)
Visually Impaired (VI)
[ ]
[ ]
Govt. Servant (GS)

Widow/Divorcee
Hearing Impaired (HI)
11. Contact Details (Note : All particulars given below in the

head should be maintained active till the end of selection
process)
a ) Address for Correspondence
Name : MR. ANOOP K
C/O : DAMODARAN K
THORAPONAM HOUSE
KOLATHUR P.O.
City/State: KASARAGOD , KERALA
Pincode: 671541 , Landline No:04994211505
b ) Permanent Address
Name : MR. ANOOP K
C/O
DAMODARAN K
THORAPONAM HOUSE
KOLATHUR P.O.
City/State: KASARAGOD , KERALA
Pincode: 671541 , Landline No:04994211505
c ) Mobile No
+91 - 9400411505
d ) Email
[email protected]
12. a) Educational Qualification (Mention all completed/result awaited/appearing)

Qualification
XII
ITI
B.Sc
Diploma
Main Subjects / Trade

(Specify Subject / Trade
as mentioned on the
Certificate / Degree of
EQR)
NA
SCIENCE
ELECTRICAL AND
ELECTRONICS
ENGINEERING
Grad.
PostGrad.
OTHERS1
OTHERS2
12. b) Higher Education
University / Board
Year of
Passing
Duration
of Course
(In years)
GENERAL
EDUCATION
DEPARTMENT KERALA
BOARD OF HIGHER
SECONDARY
EXAMINATION KERALA
2007
NA
2009
DEPARTMENT OF
TECHNICAL
EDUCATION KERALA
2012
Maximum
Marks
Marks
Obtained /
CGPA
% of Marks
Secured
1000
810
81
600
459
76.5
2800
2173
77.6
Have you Completed or persuing M.Sc./B.Tech./B.E. degree etc.? YES [ ] NO [ Y ]

Institute Name
Qualification
Likely Date/Date of Completion
13. Details of Exam Fee of Rs. 50/- Paid (If not exempted as per Govt. rules)
Payment Method
1164
Fee Amount
50.00
Payment Date
2014-10-15 22:48:04
Payment ID
29509684
Transaction ID Status
75042982
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
Performed
15. Important Endorsements

a) (i) Type of ID Proof :
(ii) Height (cm) :
Identification Mark :
(iii) Driving License :
AADHAR CARD
ID No.:
178
Weight (kg) :
A BLACK MOLE ON THE LEFT RING FINGER
591686319329
50
(ii ) Two / three Wheelers:

(i ) LMV :
(i ) HMV :
(b) For 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 ANOOP K son/Daughter of DAMODARAN K 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/appointment is liable to be cancelled.
18.
a) Left Hand Thumb Impression
b) Signature of Candidate
Place :
Date :
Note : You are NOT REQUIRED to send print out of your application to the DRDO's office at this time. How ever, we advise to keep this
Online 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.
ONLINE APPLICATION NUMBER : 90106043071
, Printed On Date :15 / 10 / 2014
22:51:4

Online Application Form

Uploaded by

Copyright:

Available Formats

Online Application Form

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Online Application Form

Uploaded by

Copyright:

Available Formats

ONLINE APPLICATION FORM

Advt. No. CEPTAM - 07

DRDO ENTRY TEST - 2014

Closing Date - 17th Oct 2014

For Office Use Only :

Scheduled Caste (SC)

Ex-Service Man (ESM)

Persons with Disability (PWD)

Govt. Servant (GS)

Hearing Impaired (HI)

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

12. a) Educational Qualification (Mention all completed/result awaited/appearing)

Main Subjects / Trade

Have you Completed or persuing M.Sc./B.Tech./B.E. degree etc.? YES [ ] NO [ Y ]

Likely Date/Date of Completion

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

Period From Period to

15. Important Endorsements

(ii ) Two / three Wheelers:

16. Other relevant information (If any)

ONLINE APPLICATION NUMBER : 90106043071

, Printed On Date :15 / 10 / 2014

You might also like