Professional Documents
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CSIRUGCJRF/NETExam
Youmustcheckyourregistrationstatuswhenitisnotifiedonourwebsitecsirhrdg.res.in
(15J)
OnlineApplicationForm
JointCSIRUGCTestforJRFandEligibilityForLectureship,NET21062015
[CouncilofScientific&IndustrialResearchHRDGroup,ExaminationUnit]
1.RollNo(TobefilledbyOfficeOnly)
2.ApplicationNo.
15J682228
15J682228
3.AppliedFor
:01JRF
4.Subject
:1CHECHEMICALSCIENCES
5.ExamCentre
:01BANBANGALORE
6.MeduimofNETExam(Asapplicable)
:02ENGLISH
7.CandidateName
:MANDLANAGARAJU
8.Sex
:MALE
9.Father/Mother/HusbandName
:FATHER>MANDALAANJANEYULU
10.DateOfBirth
:06061992
11.AgeAsOn01012015
:22Y,6M,26D
12.Category
:OBC
13.Physically/VisuallyHandicape(PH/VH)
:NA
14.IfVH,DoYouWantScribe'sHelp
:NA
15.WriteyournameandcompleteMailingAddress.
Name:
MANDLANAGARAJU
Address:
D.NO.31111,CHAKALIVEEDHI,
DEVANAKONDA(VILLAGEANDMANDAL)
KURNOOL(DIST)
City:
KURNOOL
Pin:
518465
State:
ANDHRAPRADESH
SignatureofCandidate>
16.PermanentAddress
Name
:MANDLANAGARAJU
Address
:D.NO.31111,CHAKALIVEEDHI,
DEVANAKONDA(VILLAGEANDMANDAL)
KURNOOL(DIST)City:KURNOOLPin:518465State:ANDHRAPRADESH
17.Email
:pallagopal04@gmail.com
Note:BachelorsdegreeholderswillnotbeeligibleforLectureship]
18.QualifyingDegree
:M.SC.
[CandidatesenrolledforM.Sc.orhavingcompleted10+2+3yearsofqualifyingexaminationasgivenincolumn
18,mayapplyunderResultAwaited(RA)category]
19.IfResultAwaited
:RA
20.YearOfAppearinginFinalExam
:2016(IfResultAwaited)
21.GivedetailofFinalExamResult(IfnotResultAwaited)
(a)YearOfPassing:NA(b)Division:NA(c)MarkObtained(%):0%
22.IfenrolledinMSPhDprogram
:NO
(a)Yearofenrollment
:NA
(b)Yearofpassingbachelordegree
:NA
(c)Division/Grade
:NA
(d)MarksObtained(%)
:0
http://59.163.216.82:8080/jrf/online/submit_form.jsp
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3/6/2015
CSIRUGCJRF/NETExam
ApplicationNo:
15J682228
23.Specialization:
(a)SpecializationCode:105(b)SpecializationSubjectName:ENVIRONMENTALCHEMISTRY
24(a)University/InstituteCode
:221
(b)University/InstituteName
:SRIVENKATESWARAUNIVERSITY,TIRUPATI
DECLARATION
I,MANDLANAGARAJU,herebydeclarethatallstatementsmadeinthisapplicationaretrue,completeand
correcttothebestofmyknowledgeandbeliefandintheeventofanyoftheinformationbeingfoundfalseorincorrect
oranyineligibilitybeingdetectedbeforeorafterthetestmycandidatureisliabletobecancelledandactioninitiated
againstme.
Ihavesubmittedonlyoneapplicationforthistest.
IfurtherdeclarethatIfulfillallconditionsofeligibilityregardingAgelimits,Educationalqualificationsetc.prescribedfor
thetest.
IalsodeclarethatIhaveneverbeenconvictedbyanycourtoflaw.
IdeclarethatIhavegonethroughtheconditionsattachedtoNETandshallabidebythesame.
I have enclosed the attested copies of certificate of being SC/ST/OBC/PH/VH (Physically or Visually handicapped), (strike
whichisnotapplicable).
I understand that my application will be rejected summarily if found incomplete/ineligible, and no correspondence will be
entertainedbyCSIRinthisregard.
Date:
Place:
SignatureoftheCandidate.
ATTESTATION(For'RA'CategoryOnly)
I certify that the information given by the candidate Shri/Smt/Kum MANDLA NAGARAJU has been verified by me with
referencetorecords.
Also this is certifiied that the candidate is enrolled for M.Sc. or having completed 10+2+3 years of (BS4
year/BE/B.Tech./B.Pharma/MBBS/Integrated BSMS or equivalent degree & is eligible to appear under 'RA" category as laid
downintheeligibilitycriteriaofCSIRUGCNETJune2015.(Strikewhichisnotapplicable)
SignatureoftheHeadofDept./Institute
Rubberstamp/seal
Name:
Designation:
NOTE : (Attestation should be signed by the Head of the Dept. or Institution where the candidate has appeared OR will be
appearingintheabovenotifiedQualification/DegreeExaminiationasapplicable).
25.ChallanDetail.
NameoftheBank
BranchCode
AmountinFigure(Rs.)
ChallanDate
:INDIANBANK
:00290
:500
:03/03/2015
Branch/City
JournalNo.
AmountinWord(Rs.)
Phone
:TIRUPATI
:2067811
:FIVEHUNDRED
:9676321720
SignatureofApplicant
Note:Please send hard copy of this ONLINE submitted application form duly signed with recent passport size Black & white
photograph along with a copy of original challan (fee deposit receipt) meant for CSIR(Examination Unit) with required
certificate(s) by U.P.C./ordinary Post only, as notified in the Employment News/Website by arranging your own envelop
(5X11) superscribing your subject code, application no., and centre code which should reach to the Sr. Controller of
Examination, Examination Unit, Human Resource Development Group, CSIR Complex, Library Avenue, Pusa, New Delhi
110012onorbefore17032015(23032015forremoteareas).
PleasedonotstaplethehardcopyoftheApplicationform&enclosures.
Note:*******Nochangesintheapplicationformwillbeallowedaftersubmission*****
http://59.163.216.82:8080/jrf/online/submit_form.jsp
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3/6/2015
CSIRUGCJRF/NETExam
CutandPastefollowingaddressonyourownenvelop(5X11)
(ApplicationforJointCSIRUGCTestforJRF/LS(NET),June,2015)
[1CHE|15J682228|01BAN|02ENGLISH]
To,
Sr.ControllerofExaminations
ExaminationUnit,HumanResourceDevelopmentGroup
CSIRComplex,oppositeInstituteofHotelManagement,LibraryAvenue
Pusa,NewDelhi110012
http://59.163.216.82:8080/jrf/online/submit_form.jsp
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