ONLINE APPLICATION FORM

DRDO ENTRY TEST - 2015

Advt. No. CEPTAM - 08

Cutoff/Closing Date - 8th Feb 2016

For Office Use Only :

ONLINE APPLICATION NUMBER : 80109001284
Printed On Date :20 / 01 / 2016
8. Nationality : INDIAN
9. Willing to serve in Remote Area # : NO
10. Gender :Male [ Y ] Female [ ]

1. POST NAME & CODE

STA'B' -[0109-ELECTRONICS OR ELECTRONICS &
COMMUNICATION OR ELECTRONICS &
TELECOMMUNICATION]
2. Preference For Exam City
I. 12-HYDERABAD
II. 25-VISAKHAPATNAM
III. 03-BENGALURU
3. Candidate's Name as Recorded in X Class Certificate
MYLA HEMANTHKUMAR
4. Father's Name
MYLA SIVANAGESWARA RAO
5. Mother's Name
MYLA RAJESWARI
6. Date of Birth (as recorded in X Class Certificate)
10 / 04 / 1992 , Age as on Cutoff Date 23Y, 9M, 28D
7. a) Category
[Y]
[ ]

Unreserved (UR)
Scheduled Tribe (ST)

[ ]
[ ]

Scheduled Caste (SC)

Other Backward Class
(OBC)

[Y]
[ ]

Govt. Servant (GS)

Widow/Divorcee

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

head should be maintained active till the end of recruitment
process)
a ) Address for Correspondence
Name : MR. MYLA HEMANTHKUMAR
C/O : MYLA SIVANAGESWARA RAO
PLOT NO 89,ROAD NO-3N
BHAVANI NAGAR,KAPRA
ECIL POST
City/State: HYDERABAD , ANDHRA PRADESH
Pincode: 500062 , Landline No:
b ) Permanent Address
Name : MR. MYLA HEMANTHKUMAR
C/O
MYLA SIVANAGESWARA RAO
PLOT NO 89,ROAD NO-3N
BHAVANI NAGAR,KAPRA
ECIL POST
City/State: HYDERABAD , ANDHRA PRADESH
Pincode: 500062 , Landline No:

7. b) Sub-Category
[ ]
[ ]

Ex-Service Man (ESM)

Meritorious Sports
Person (MSP)

[ ]

Persons with Disability (PWD)

[ ]

Orthopaedically
Handicapped (OH)
Visually Impaired (VI)

[ ]

[ ]

c ) Mobile No
+91 - 9493767162
d ) Email
coolhemanth11@gmail.com

Hearing Impaired (HI)

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

Qualification

XII
ITI
B.Sc
Diploma

Graduation

Main Subjects / Trade

as mentioned on the
Certificate / Degree of
EQR
NA

University / Board / Roll Year of

No.
Passing

Duration
of Course
(In years)

BOARD OF
SECONDARY
EDUCATION AP

2007

NA

ELECTRONICS AND
COMMUNICATION
ENGINEERING
ELECTRONICS AND
COMMUNICATION
ENGINEERING

GOVERNMENT
POLYTECHNIC
HYDERABAD
LAKIREDDDY BALI
REDDY COLLEGE OF
ENGINEERING

2010

2013

PostGrad.
OTHERS1
OTHERS2
12. b) Higher Qualification [for post of STA 'B' / Tech 'A']

Maximum
Marks /
CGPA

Marks /
CGPA
Obtained

% of Marks
Secured

600

527

87.83

3450

2779

80.55

4250

3321

78.14

Have you Completed or pursuing M.E/M.TECH/PhD/M.Sc./B.Tech./B.E./AMIE/AMIETE etc.? YES [ Y ] NO [ ]

Institute Name
Qualification
Status
Completion / Likely
Completion Date
LAKIREDDY BALI REDDY COLLEGE OF
BTECH
COMPLETED
29/05/2013
ENGINEERING

13. Details of Exam Fee of Rs. 50/- Paid (If not exempted as per Govt. rules)
Payment Method
API

Fee Amount
50.00

Payment Date
2016-01-20 04:05:43

Payment ID
47530934

Transaction ID Status
125768644
Processed

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

Name of Organization

BSNL

Post Held

TTA

Pay Scale /
Grade Pay
1360025420

Period From Period to

Nature of Duties
(dd/mm/yyyy (dd/mm/yyyy Performed
)
)
31/05/2014
08/02/2016
MAINTENANCE OF
OPTICAL FIBER CABLES
AND SYSTEMS

15. Important Endorsements

a) (i) Type of ID Proof :
PAN CARD
ID No.:
(ii) Height (cm) :
162 (5 Feet 3 Inch)
Weight (kg) :
Identification Mark :
A MOLE ON LEFT HAND MIDDLE FINGER
(iii) Driving License : [for post of vehicle operator 'A' only]
(ii ) Two / Three Wheelers:
(i ) LMV :
(i ) HMV :

BVVPM8195B
71

(b) For the 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 MYLA HEMANTHKUMAR son/Daughter of MYLA SIVANAGESWARA RAO 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 : 80109001284

, Printed On Date :20 / 01 / 2016