SECTION C APPLICATION FORM

Affix Recent (not more than 30 days old) Passport size coloured Photograph with Name and Date on Photograph Self Attested
(Candidate must keep 7 copies of the same photograph with them for future use)

DRDO ENTRY TEST 2013

VALID FOR POSTS IN PART-2 OF SECTION A (TECH-A/ADMIN & ALLIED CADRE)

Closing Date: 27th May, 2013

(THIS FORM IS NOT VALID FOR THE POSTS OF STA-B. APPLICANTS FOR THESE POSTS MUST APPLY ONLINE ONLY)
For Office Use Only:

Signature of the Candidate Left Hand Thumb Impression

SMS Registration No:

7. Nationality

1. Post Code (See Advt.)

2. Preference for Exam City (Write Code)

I. II. III.

8. Gender Male Female 9. All particulars given below should be maintained active till the end of selection process a) Address for Correspondence (Capital Letters)

3. Candidates Name as recorded in X Class Certificate:

(Leave one blank space between parts of the name)

4.

Fathers / Mothers / Husbands Name

(Leave one blank space between parts of the name)

______________________________ ________________________________ ADDRESS: ____________________________ ___________________________________ ___________________________________

NAME: C/o: STATE: PIN:

5. Date of Birth (As recorded in X Class Certificate)

D D M M Y Y Y Y

b) Permanent Address (Capital Letters)

6.

Category

(Please tick () in the appropriate Box(es))

a) Category
Unreserved (UR) Scheduled Tribe (ST) Scheduled Caste (SC) Other Backward Class (OBC)

______________________________ ________________________________ ADDRESS: ____________________________ ___________________________________ ___________________________________

NAME: C/o: STATE: PIN:

b) Sub-category
Ex-Service Man (ESM) Govt. Servant (GS)

c) Telephone Nos.

Meritorious Sports Person (MSP) Widow/Divorcee ------------------------------------------------------------------------------------------PERSONS WITH DISABILITY (PWD) ------------------------------------------------------------------------------------------Orthopaedically Handicapped (OH) Hearing Impaired (HI) Visually Impaired (VI)

Landline
With STD CODE

Mobile
d) E-mail

_________________________@_____________________ 10. (a) Educational Qualifications (Attach Self Attested Photo Copy as Proof)
Main Subjects/ Trade (Specify subject/trade as mentioned on the certificate/degree of EQR) University/ Board Year of Passing Duration of Course (in years) Marks Obtained & Maximum Marks % of Marks Secured

Qualification

X XII ITI

* *

Diploma

BA / BCom / BSc * MSc/BE/BTech/ PhD or Higher Qualification etc Others/ Pursuing 10. (b) Specify Subject/Trade * as mentioned on certificate/diploma/degree of EQR : _________________________________________

11. Fee Paid through IPO If yes, details of IPO Name of Post Office

O Yes

No

Exempted (SC/ST/ESM/PWD/Women etc)

Serial No(s). of IPO

Date of Issue

Amount (` )

12. Employment Record in Govt./PSU/Autonomous Body etc (if any). (Forward application through proper channel with advance copy before closing date) Name of Organization Post Held Pay Scale/Grade Pay Period From To Nature of Duties performed

13. Important Endorsements (a) (i) Mention Photo Identity Proof details (PAN Card /Voter Id/Passport/College Id/Aadhar/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 Id Proof___________________________________ (ii) 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: Yes Do you have Driving License valid throughout India for all three type of vehicles :

No

If yes, Likely Date of completion_________ No If yes, Date of issue __________ No If yes, Date of issue __________ No If yes, Date of issue __________

(iii) For the post of Civilian Driver A & Fire Engine Driver only ( Must enclose copy of Driving License ) (i) Two/Three Wheeler: (ii) LMV : (iii) HMV: Yes Yes Yes

(b)

For the serving Defence personnel only, claiming benefits of Ex-Serviceman The application of (Rank) ... (Name) (Date of Birth) (Date of Joining) . (Date of Discharge) is hereby forwarded with the affirmation that we have no objection to his/her application being considered. Office Seal and Date Signature of Competent Authority

14. Any other relevant information / Specific requirements by VI candidates, if any. .... 15. Declaration: I ... Son/Daughter/Wife of 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. 16. (a) Left Hand Thumb Impression (b) Signature of Candidate

Place: 17.

Date:

Please tick mark ( ) the following CHECK LISTa) Application Form duly signed on both pages and coloured photograph (with Name and date of photo) pasted. b) c) d) e) f) g) h) Proof of Age (i.e. self attested copy of X-Class Certificate) attached Self Attested Copies of EQR Certificates attached. Self Attested Copies of Driving License attached. (For Civilian Driver A and Fire Engine Driver A only) Copy of Id Proof (as per details filled in application form) attached (NO ENTRY IN EXAMINATION CENTRE WITHOUT ID PROOF). IPO for examination fee, if applicable attached. Self Attested Copies of SC/ST/OBC/PWD/ESM etc if claimed, certificates attached. Self addressed stamped post card (indicating post code, post name & subject) for acknowledgment at the end of all enclosures attached.

Note: Candidates are advised to keep the photocopy of their application form and copy of the Advertisement for claiming travel concession from Railways,
and also for future references. Apply exactly on this format on A4 size (210X297mm) white plain paper. 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.