DRDO Online Application

http://drdo.res.in/cgibin/ceptam05/print_application.php?ID=0fde206ffba...

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Advt No.- CEPTAM - 05 SECTION 'C'
IMPORTANT: READ INSTRUCTIONS BEFORE FILLING THE FORM. FORM & TESTIMONIALS SHOULD BE ON A-4 SIZE PAPER ONLY. KEEP PHOTOCOPY OF YOUR APPLICATION FORM FOR CLAIMING TRAVEL CONCESSION FROM RAILWAYS.

Closing Date: 09

th

April, 2012

APPLICATION FORM DRDO ENTRY TEST-2012

Your Online Apply Id : 0105-94221 (* Remember this ID and Date of Birth you filled in Application form to the take Print out Later)

Affix Recent (not more than 30 days old) Passport size coloured Photograph, Self attested
(Candidate must retain 7 copies of the same photograph for future use)

Signature of the candidate

For Office Use Only:

Left Hand Thumb Impression

7. Nationality : 8. Gender :

Indian Female

1. Post Code: 2. Exam City Code: 3. Candidate's Name: 4. Father's Name 5. A) Date of Birth
(as recorded in X Class Certificate)

0105-STA 'B' (Chemistry) 16-Kanpur, 08-Dehradun, 01-Agra AAKANSHA SINGH Sh. RAJENDRA SINGH

9. A) Address for corespondence (This shall be used till the end of the selection process) (Capital Letters) Name: C/o: Address: AAKANSHA SINGH Sh. RAJENDRA SINGH A-1093/13 INDIRA NAGAR LUCKNOW NEAR LEKHRAJ MARKET LUCKNOW, UTTAR PRADESH Pincode-226016

07 Feb 1987 25 Year(s) 2 Month(s) 2 Day(s) No

Age as on Closing Date B) (i)Are you seeking Age relaxation

B) Permanent Address (Capital Letters) Name: C/o: Address: AAKANSHA SINGH Sh. RAJENDRA SINGH A-1093/13 INDIRA NAGAR LUCKNOW NEAR LEKHRAJ MARKET LUCKNOW, UTTAR PRADESH Pincode-226016

6. Category (Please tick () in the appropriate Box(es)) Category Unreserved (UR) Sub-Category

C) Telephone Nos. Landline: Mobile : 9235853115

D) E-mail : aakanshasingh1987@gmail.com 10. Educational Qualifications (Attach Self Attested Copy as Proof) Examination Passed / Appearing X
th

Main Subjects / Trade

University / Board U.P.BOARD U.P.BOARD

Year of Duration Passing of Course 2002 2004 1 YEAR 2YEARS

% of Division Marks secured 70.5% 74.6% FIRST FIRST

HINDI,ENGLISH,SCIENCE,HOME SCIENCE,ART,S.SCIENCE HINDI ,ENGLISH,PHYSICS,CHEMISTRY,BIOLOGY

XII in SCIENCE

th

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DRDO Online Application

http://drdo.res.in/cgibin/ceptam05/print_application.php?ID=0fde206ffba...

B.Sc. in CHEMISTRY 11) Fee Details

CHEMISTRY,ZOOLOGY,BOTANY

LUCKNOW UNIVERSITY

2009

3 YEARS

73%

FIRST

Name of Post Office NEW HYDERABAD LUCKNOW UP

Serial No(s). of IPO 54G794901

Date of Issue 30 Mar 2012

Amount (Rs.) 50

12. Mention details if registered in Employment Exchange (Optional) Name & Address of Employment Exchange 13. Employment Record in Govt./PSU/Autonomous Body etc. Name of Organization DR.REDDY'S LABOURATIES HYDERABAD 14. Important Endorsements (A) (a) Type of ID Proof : PAN CARD (ii) No. : CHKPS6710C (iii) Date of Issue : 2009-08-18 (iii) Issued by : INCOME TAX DEPARTMENT (b) For the Post of STA 'B' & Technician 'A' only (i) Do You possess M.sc./B.Tech/B.E. Degree/Ph.D : Yes (a) Degree & Subject : M.Sc - CHEMISTRY (b) Date of Admission : 2009-08-18 (b) Date of Completion : 2011-05-17 (i) Are You persuing M.sc./B.Tech/B.E. Degree/Ph.D : (c) For the Civilian Driver 'A' & Fire Engine Driver only (i) Do you have Driving License for LMV & HMV : (B) For the serving Defence personnel claiming benefits of Ex-serviceman only 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. Post Held SENIOR EXECUTIVE Pay Scale / Grade Pay 17000/MONTH Period From 25 May 2009 To 19 Dec 2011 Nature of Duties performed RESEARCH & DEVELOPMENT Registration No. Date of Registration

Office Seal and Date 15. Any other relevant information : ...................................................... 16. Declaration :

Signature of Competent Authority

I AAKANSHA SINGH Son/Daughter/Wife of Sh. RAJENDRA SINGH hereby declare that: a. 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 have submitted only one application for one Post in response to this advertisement. c. I have read and understood all the provisions mentioned in the advertisement and undertake to abide by them. 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. 17. (A) Left hand Thumb Impression (B) Signature of Candidate

Place: ........................................

Date: ........................................

18. Please tick mark() the following CHECK LIST-

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DRDO Online Application

http://drdo.res.in/cgibin/ceptam05/print_application.php?ID=0fde206ffba...

i) Application Form duly signed on both pages and coloured photograph pasted ii) Self Attested Copies of all required Certificates/Documents/Driving License etc. attached iii) Proof of Age (i.e. self attested copy of X-Class Certificate) attached iv) Copy of ID Proof (Details filled in application form) attached. v) IPO for examination fee, if applicable attached vi) Self Attested copies of SC/ST/OBC/PWD etc certificate attached, if claimed vii ) Self addressed stamped post card(indicating post code, post name & subject) at the end of enclosures for acknowledgment attached. viii) Seven (07) prints of same photograph as pasted on Application form retained

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