Online Application Form Advt. No. CEPTAM - 08

ONLINE APPLICATION FORM
Advt. No. CEPTAM - 08 DRDO ENTRY TEST - 2015 Cutoff/Closing Date - 8th Feb 2016
For Office Use Only :
ONLINE APPLICATION NUMBER : 80115000033
Printed On Date :25 / 01 / 2016
8. Nationality : INDIAN
9. Willing to serve in Remote Area # : NA
10. Gender :Male [ Y ] Female [ ]
11. Contact Details (Note : All particulars given below in the

head should be maintained active till the end of recruitment
1. POST NAME & CODE process)
STA'B' -[0115-METALLURGY] a ) Address for Correspondence
2. Preference For Exam City
Name : MR. ASHISH KUMAR
I. 24-RANCHI
II. 18-KOLKATA C/O : BIRENDRA KUMAR SINGH
III. 20-PATNA QR NO NEW L4-29
3. Candidate's Name as Recorded in X Class Certificate JEMCO COLONY
ASHISH KUMAR TELCO WORKS
4. Father's Name City/State: JAMSHEDPUR , JHARKHAND
BIRENDRA KUMAR SINGH Pincode: 831004 , Landline No:
5. Mother's Name
SNEHLATA SINGH b ) Permanent Address
6. Date of Birth (as recorded in X Class Certificate)
31 / 12 / 1988 , Age as on Cutoff Date 27Y, 1M, 7D Name : MR. ASHISH KUMAR
C/O BIRENDRA KUMAR SINGH
7. a) Category
QR NO NEW L4-29
[Y] Unreserved (UR) [ ] Scheduled Caste (SC) JEMCO COLONY
[ ] Scheduled Tribe (ST) [ ] Other Backward Class TELCO WORKS
(OBC)
City/State: JAMSHEDPUR , JHARKHAND
7. b) Sub-Category Pincode: 831004 , Landline No:
[ ] Ex-Service Man (ESM) [ ] Govt. Servant (GS)
[ ] Meritorious Sports [ ] Widow/Divorcee c ) Mobile No
Person (MSP) +91 - 7856996933
[ ] Persons with Disability (PWD) d ) Email
[email protected]
[ ] Orthopaedically [ ] Hearing Impaired (HI)
Handicapped (OH)
[ ] Visually Impaired (VI)
12. a) Educational Qualifications (Must mention all completed/result awaited/appearing)
Qualification Main Subjects / Trade University / Board / Roll Year of Duration Maximum Marks / % of Marks
as mentioned on the No. Passing of Course Marks / CGPA Secured
Certificate / Degree of (In years) CGPA Obtained
EQR
X NA JAC RANCHI 0115 2004 NA 500 305 61
XII PHY CHEM MATHS JAC RANCHI 10012 2006 2 500 264 52.8
ITI
B.Sc
Diploma STEEL MAKING IRON SBTE RANCHI 2010 3 2424 1811 74.71
MAKING ETC 3213672453
Graduation
PostGrad.
OTHERS1
OTHERS2
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 [ ] NO [ Y ]
Institute Name Qualification Status Completion / Likely
Completion Date
13. Details of Exam Fee of Rs. 50/- Paid (If not exempted as per Govt. rules)
Payment Method Fee Amount Payment Date Payment ID Transaction ID Status

1032 50.00 2016-01-25 16:03:44 47822140 126806071 Processed
14. Employment Record in Govt./PSU/Autonomous Body etc. (If any)
Name of Organization Post Held Pay Scale / Period From Period to Nature of Duties
Grade Pay (dd/mm/yyyy (dd/mm/yyyy Performed
) )
TATA STEEL JUNIOR ENGINEER 17420 01/09/2010 17/01/2016 SUPERVISOR
15. Important Endorsements
a) (i) Type of ID Proof : AADHAR CARD ID No.: 697903583571

(ii) Height (cm) : 167 (5 Feet 5 Inch) Weight (kg) : 75
Identification Mark : A MOLE ON LEFT CHIN
(iii) Driving License : [for post of vehicle operator 'A' only]
(ii ) Two / Three Wheelers:
(i ) LMV :
(i ) HMV :
(b) For the serving defence personnel only, claiming benefit of Ex-Serviceman
Name of Unit Rank Date of Date of CO Name Contact NO.

Joining Discharge
16. Other relevant information (If any)
17. Declaration
I ASHISH KUMAR son/Daughter of BIRENDRA KUMAR SINGH 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
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 : 80115000033 , Printed On Date :25 / 01 / 2016

Online Application Form Advt. No. CEPTAM - 08

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ONLINE APPLICATION FORM

For Office Use Only :

ONLINE APPLICATION NUMBER : 80115000033

Printed On Date :25 / 01 / 2016

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

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

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

Payment Method Fee Amount Payment Date Payment ID Transaction ID Status

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

15. Important Endorsements

a) (i) Type of ID Proof : AADHAR CARD ID No.: 697903583571

Name of Unit Rank Date of Date of CO Name Contact NO.

16. Other relevant information (If any)

18. Required at the time of document verification/trade test/interview, if shortlisted.

19. List Of Documents Uploaded

# for details, read CEPTAM-08 advertisement

ONLINE APPLICATION NUMBER : 80115000033 , Printed On Date :25 / 01 / 2016

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