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ONLINE APPLICATION FORM

Advt. No. CEPTAM - 08 DRDO ENTRY TEST - 2015 Cutoff/Closing Date - 8th Feb 2016

1. POST NAME & CODE

STA'B' -[0107-ELECTRICAL & ELECTRONICSENGINEERING]

2. Preference For Exam City

I. 12-HYDERABAD II. 19-NAGPUR III. 25-VISAKHAPATNAM

3. Candidate's Name as Recorded in X Class Certificate

SANTHOSH GUDURU

4. Father's Name

SRINIVAS GUDURU

5. Mother's Name

LAXMI GUDURU

6. Date of Birth (as recorded in X Class Certificate)

11 / 04 / 1991 , Age as on Cutoff Date 24Y, 9M, 27D

7. a) Category

[ ] Unreserved (UR) [ ] Scheduled Caste (SC)

[ ] Scheduled Tribe (ST) [ Y ] Other Backward Class(OBC)

7. b) Sub-Category

[ ] Ex-Service Man (ESM) [ ] Govt. Servant (GS)

[ ] Meritorious SportsPerson (MSP)

[ ] Widow/Divorcee

[ ] Persons with Disability (PWD)

[ ] OrthopaedicallyHandicapped (OH)

[ ] Hearing Impaired (HI)

[ ] Visually Impaired (VI)

For Office Use Only :

ONLINE APPLICATION NUMBER : 80107059459

Printed On Date :24 / 01 / 2016

8. Nationality : INDIAN

9. Willing to serve in Remote Area # : YES

10. Gender :Male [ Y ] Female [ ]

11. Contact Details (Note : All particulars given below in thehead should be maintained active till the end of recruitmentprocess)

a ) Address for Correspondence

Name : MR. SANTHOSH GUDURU

C/O : GUDURU SRINIVAS

JAKEER HUSSAIN NAGAR

1-7-203/1/1

SURYAPET

City/State: NALGONDA , TELANGANA

Pincode: 508213 , Landline No:

b ) Permanent Address

Name : MR. SANTHOSH GUDURU

C/O GUDURU SRINIVAS

JAKEER HUSSAIN NAGAR

1-7-203/1/1

SURYAPET

City/State: NALGONDA , TELANGANA

Pincode: 508213 , Landline No:

c ) Mobile No

+91 - 9703158591

d ) Email

santhoshgusa@gmail.com

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

Qualification Main Subjects / Tradeas mentioned on theCertificate / Degree ofEQR

University / Board / RollNo.

Year ofPassing

Durationof Course(In years)

MaximumMarks /CGPA

Marks /CGPAObtained

% of MarksSecured

X NA SSC 0796449 2006 NA 600 481 80.16

XII

ITI

B.Sc

Diploma EEE SBTET 06027EE037 2009 3 3450 2446 70.91

Graduation EEE JNTUH 09915A0208 2012 3 4250 3336 78.38

PostGrad. PEED JNTUH 12J21D5407 2014 2 1600 1079 67.44

OTHERS1

OTHERS2

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

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 / LikelyCompletion Date

JOGINAPALLY B R ENG. COLLEGE MTECH COMPLETED 21/11/2014

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

Payment Method Fee Amount Payment Date Payment ID Transaction ID Status

1162 50.00 2016-01-24 08:06:02 47755175 126566106 Processed

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

Name of Organization Post Held Pay Scale /Grade Pay

Period From(dd/mm/yyyy

)

Period to(dd/mm/yyyy

)

Nature of DutiesPerformed

15. Important Endorsements

a) (i) Type of ID Proof : AADHAR CARD ID No.: 844576002579

(ii) Height (cm) : 175 (5 Feet 8 Inch) Weight (kg) : 80

Identification Mark : A MOLE ON THE RIGHT HAND LITTLE FINGER

(iii) Driving License : [for post of vehicle operator 'A' only]

(ii ) Two / Three Wheelers:

(i ) LMV :

(i ) HMV :

(b) For the serving defence personnel only, claiming benefit of Ex-Serviceman

Name of Unit Rank Date ofJoining

Date ofDischarge

CO Name Contact NO.

16. Other relevant information (If any)

17. Declaration I SANTHOSH GUDURU son/Daughter of SRINIVAS GUDURU 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 orafter 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.

Place :

Date :

a) Left Hand Thumb Impression b) Signature of Candidate

19. List Of Documents Uploaded

10th Class or Equivalent Certificate , EQR , Caste Certificate

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 alsofor future references. CEPTAM does not undertake any scrutiny of application before examination and the eligibility is verified only afterexamination. Accordingly, mere allowing the candidates to appear in the examination will not be construed as a ground of being eligible forthe post applied.

# for details, read CEPTAM-08 advertisement

ONLINE APPLICATION NUMBER : 80107059459 , Printed On Date :24 / 01 / 2016