Application Form 901110026406

Advt. No. CEPTAM-09/STA-B DRDO ENTRY TEST-2018 Crucial date of Eligibility-29-08-2018

For Office Use Only

Online Application Number: 901110026406
Generated On Date: 30/08/2018 06:10

8. Nationality: INDIAN
9. Identity Proof
9. Type: Aadhaar Card No. 6728 6002 4187
10. Gender: Male
1. Post Code & Post Name: [STA-B]-0111-Electronics or
Electronics & Communication or Electronics &
11. Contact Details:
Telecommunication Engineering
2. Exam City Preference:08-CHANDIGARH, 11-DELHI NCR, 01- a) Correspondence Address: VILLAGE KAYAO,WARD NO 4
AGRA KAYAO
3. Candidate’s Name: RAVI KANT District: Shimla City: SHIMLA
4. Father’s Name: DES RAJ State: HIMACHAL PRADESH Pincode: 172101
5. Mother’s Name: PUSHPA DEVI
6. Date of Birth: 03/02/1991 (if Permanent Address same as Correspondence Address) [ ]

Age as on Crucial Date: 27Y,6M,26D b) Permanent Address: VILLAGE KAYAO,WARD NO 4

KAYAO
7.a) Category District: Shimla City: SHIMLA
[ ] Unreserved(UR) [ ] Scheduled Caste (SC) State: HIMACHAL PRADESH Pincode: 172101
[ ] Scheduled Tribe (ST) [ ] OBC (Creamy Layer)
[ ] OBC (Non-Creamy Layer) c) Mobile No: 9816424212
d) Alternate No: 9816879723
e) Email ID: rmukhyia@gmail.com

12. Essential Qualifications

a) Do you possess EQR as per CEPTAM-09/STA-B Advt. (Diploma /B.Sc.) as on crucial date of eligibility: YES[ ] No[ ]
b) Do you possess B.Sc./Diploma/Both : B.Sc.[ ] Diploma [ ] Both(Diploma and B.Sc.)[ ]

Mode of
University/ Year of Max. Marks/ Marks/ CGPA % of Marks
Qualification Degree/ Main Subject Roll No.
Board Passing CGPA obtained Secured
Qualification
ENGLISH
MATHMATICS
HINDI SOCIAL
SCIENCE
X Regular SCIENCE AND 685211 HPBOSE 2007 700.00 510.00 72.80
TECH
SANSKRIT
INFORMATIO
N TECH
PHYSICS
CHEMISTRY
XII Regular MATH 3005774 HPBOSE 2010 500.00 300.00 60.00
ENGLISH PHY
EDUCATION
ELECTRONIC
S AND
Diploma Regular 10051080622 HPTSB 2013 4187.00 2961.00 70.70
COMMUNICAT
ION
c) Subject mentioned on EQR: BASIC ELECTRONICS DIGITAL POWER ELECTRONICS PLC COMMUNICATION SYSTEM
NETWORK FILTERS AND TRANSMISSION LINE MICRO CONTROLLERS MICRO PROCESSOR
d) Higher Qualification (B.E., B.Tech, M.Sc, M.Tech, Ph.D., etc)
Are you Pursuing YES[ ] NO [ ] Have you Completed YES [ ] NO [ ]
Degree Likely Date of Completion Degree Likely Date of Completion
B.Tech 10/08/2019 NA NA
13. a) Details of Application Fee of Rs. 100/- Paid (If not exempted as per Govt. rules)

Payment Method Fee Amount Payment Date Payment ID Transaction ID Status

APTC0000308441201 201808301112128001
DC 100.00 30/08/2018 TXN_SUCCESS
80830060836 10168834435167835
14. Physical Measurements:
a) Height (cm): 172.00 b) Weight(kg): 61.00 c) Visible Identification Mark: CUT ABOVE LEFT EYE
15. Special Categories (if any) :
a) Do you belong to Minority community: Yes [ ] No[ ]
b) Domiciled in J&K during 01/01/1980 to 31/12/1989 : Yes[ ] No [ ]
c) Defence Personnel with Disability: YES [ ] NO [ ]
16.Posting Preference

Preference 1 2 3 4 5 6 7 8 9 10
Location
D1 H2 B2 J2 B1 D2 P2 K2 M1 C2
(City Code)
17.List of Documents Uploaded
10th class or equivalent Certificate , EQR Certificate
I hereby give my consent to disclose my particulars, score and rank of examination publically (refer 5.2 of CEPTAM-
09/STA-B Advertisement) on the website. [ ] Yes [ ] No
18. Declaration
I RAVI KANT son/daughter of DES RAJ hereby declare that
a) I have read and understand 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.
19. Required at the time of document verification, if shortlisted

Place:

Date:

a) Left Hand Thumb Impression b) Signature of Candidate

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 Detailed 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: 901110026406 , Generated on 30/08/2018 06:10