CENTRE FOR PERSONNEL TALENT MANAGEMENT (CEPTAM)

Advertisement No. CEPTAM-03 Closing Date: 30th Nov 2009

APPLICATION FORM
IMPORTANT: AFFIX RECENT PASSPORT SIZE (35 x 45 mm)
COLOURED PHOTOGRAPH (Should not be more
than one month old)
• READ INSTRUCTIONS BEFORE FILLING
DO NOT STAPLE
THE FORM.
• FORM & TESTIMONIALS SHOULD BE ON
A-4 SIZE PAPER ONLY.
• KEEP PHOTOCOPY OF YOUR
APPLICATION FORM FOR CLAIMING
TRAVEL CONCESSION FROM RAILWAYS.

Your Online Apply Id: 0110-29857

(* Remember this ID and Date of Birth you
filled in the Application form to take Print out
Later)
1. Nationality : Indian Signature of the Candidate within the box
2. Post Details:
Post Code Name of Post Applied For
0110 STA 'B' (Mechanical)
3. Fees Details: Fees Paid
A) Details of IPO
Issuing Post Office Serial No. of IPO Date of Issue Amount (Rs.)
AUDUGODI 41G747925 26-11-2009 50
4. Applicant's Name SHEKARA.S
5. Father's Name Mr. SATHYANARAYANA.V
6. Address
(a) For correspondence (b) Permanent address
S/O SATHYANARAYANA.V S/O SATHYANARAYANA.V
#83, 3RD CROSS #83, 3RD CROSS
VINAYAKANAGAR VINAYAKANAGAR
AUDUGODI POST AUDUGODI POST
BANGALORE BANGALORE
KARNATAKA KARNATAKA
Pincode-560030 Pincode-560030
(c) Phone (i) - (ii) Mobile 9632174840
(d) Email Id shekaras2@gmail.com
7. (a) Date of Birth 22-02-1982
(as recorded in Matriculation/ Equivalent
Certificate)
(b) Are you seeking age relaxation? Yes (If yes please attach proof.)
8. Gender Male
9. Category/ Reservation claimed, Please tick() in the appropriate Box (You need to send the proof on standard format)

Category Reservation Sub-Category Claimed If PH, indicate Sub-Category

Other Backward Class (OBC)
10. Choice of Exam City Bangalore
11. Educational & Professional Qualifications (Attach proofs *)

Examination Year of Marks Total

Subjects/Trade University/Board Percentage
Passed Passing Obtained Marks
10th ENGLISH, HINDI SSLC 1997 437 625 69.92 %

ITI in TURNER GOVT. ITI, HOSUR ROAD 1999 521 700 74.43 %
TURNER
Diploma in WELDING AND SRI JAYACHAMARAJENDRA 2008 3981 5275 75.47 %
SHEETMETAL GOVT., POLYTECHNIC
MECHANICAL
12. Employment Record in Govt./PSU/Autonomous Body etc. (Attach proofs *)

Name of Pay Scale/Grade Period

Post Held Nature of Duties performed
Organization Pay From To
TVS MOTOR DESIGNER 10000 04-08- DESINGNING OF PLASTIC AND SHEETMETAL
COMPANY LTD. 2008 PARTS OF 2 WHEELER AND 3 WHEELERS
13. Mention details if registered in Employment Exchange

Name & Address of Employment Exchange Registration No. Date of Registration

14. Other Relevant information if any

OBC CERTIFICATE SHALL BE SUBMITTING ON EXAM DAY
15. Declarations
A. I SHEKARA.S Son/Daughter/Wife of Mr. SATHYANARAYANA.V hereby declare that all the statements made in this
application are true, complete and correct to the best of my knowledge and belief and have filled in my own handwriting.
B. I also declare that I have submitted only one application for one Post code in response to this advertisement.
C. I have also enclosed duly attested and legible copies of all the relevant documents/certificates.
D. The information submitted herein shall be treated as final in respect of my candidature for the post applied.
E. I declare that I have read and understood all the provisions mentioned in the advertisement and hereby undertake to abide by
them. I further undertake to serve anywhere in India including field condition/remote areas.
F. 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. Details of Enclosures Attached
1) Proof of Age
2) Proof of Qualification
3) Fees through IPO
17. (A) Signature of Candidate 17. (B) Left hand Thumb Impression
PLACE: .......................................

DATE : .......................................... 17. (C) Name______________________________________