ONLINE APPLICATION FORM

DRDO ENTRY TEST - 2015

Advt. No. CEPTAM - 08

Cutoff/Closing Date - 8th Feb 2016

For Office Use Only :

ONLINE APPLICATION NUMBER : 80114014289
Printed On Date :13 / 03 / 2016
8. Nationality : INDIAN
9. Willing to serve in Remote Area # : NO
10. Gender :Male [ Y ] Female [ ]

1. POST NAME & CODE

STA'B' -[0114-MECHANICAL ENGINEERING]
2. Preference For Exam City
I. 07-CHENNAI
II. 03-BENGALURU
III. 17-KOCHI
3. Candidate's Name as Recorded in X Class Certificate
ARUNPRASATH M
4. Father's Name
MUTHUSAMY N
5. Mother's Name
SUMATHI N
6. Date of Birth (as recorded in X Class Certificate)
27 / 06 / 1986 , Age as on Cutoff Date 29Y, 7M, 11D
7. a) Category
[Y]
[ ]

Unreserved (UR)
Scheduled Tribe (ST)

[ ]
[ ]

Scheduled Caste (SC)

Other Backward Class
(OBC)

[ ]
[ ]

Govt. Servant (GS)

Widow/Divorcee

7. b) Sub-Category
[ ]
[ ]

Ex-Service Man (ESM)

Meritorious Sports
Person (MSP)

[ ]

Persons with Disability (PWD)

[ ]

Orthopaedically
Handicapped (OH)
Visually Impaired (VI)

[ ]

[ ]

Hearing Impaired (HI)

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. ARUNPRASATH M
C/O : NANDAGOPALAN
81 TEACHER'S COLONY
PARAMATHI - POST
NAMAKKAL - DIST
City/State: NAMAKKAL , TAMIL NADU
Pincode: 637207 , Landline No:
b ) Permanent Address
Name : MR. ARUNPRASATH M
C/O
NANDAGOPALAN
81 TEACHER'S COLONY
PARAMATHI - POST
NAMAKKAL - DIST
City/State: NAMAKKAL , TAMIL NADU
Pincode: 637207 , Landline No:
c ) Mobile No
+91 - 9791533445
d ) Email
arun1986.m@gmail.com

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

Qualification

X
XII
ITI
B.Sc
Diploma
Graduation
PostGrad.

Main Subjects / Trade

as mentioned on the
Certificate / Degree of
EQR
NA
GENERAL
MACHINIST

MECHANICAL
MEACHANICAL
ENGINEERING
DESIGN

University / Board / Roll Year of

No.
Passing

Duration
of Course
(In years)

Maximum
Marks /
CGPA

Marks /
CGPA
Obtained

% of Marks
Secured

257229
602546

2001
2003

NA
2

500
1200

238
777

48
65

2375051
20901260411
621813408001

2015
2012
2015

2
3
2

2400
10
10

1750
8.88
7.71

73
89
77

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 / Likely
Completion Date

PGP COLLEGE OF ENGINEERING AND

TECHNOLOGY

ME

COMPLETED

20/07/2015

13. Details of Exam Fee of Rs. 50/- Paid (If not exempted as per Govt. rules)
Payment Method
1143

Fee Amount
50.00

Payment Date
2016-01-21 19:22:01

Payment ID
47627771

Transaction ID Status
126112620
Processed

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

Name of Organization

Post Held

Pay Scale /
Grade Pay

Period From Period to

Nature of Duties
(dd/mm/yyyy (dd/mm/yyyy Performed
)
)

15. Important Endorsements

a) (i) Type of ID Proof :
AADHAR CARD
(ii) Height (cm) :
165 (5 Feet 4 Inch)
Identification Mark :
MOLE ON NACK BACKSIDE
(iii) Driving License : [for post of vehicle operator 'A' only]
(ii ) Two / Three Wheelers:
(i ) LMV :
(i ) HMV :

ID No.:
Weight (kg) :

331623573595
70

(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 ARUNPRASATH M son/Daughter of MUTHUSAMY N 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 : 80114014289

, Printed On Date :13 / 03 / 2016