SECTION C

Closing Date: 09 April, 2012

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

APPLICATION FORM DRDO ENTRY TEST 2012

For Office Use Only:

Signature of the Candidate Left hand Thumb Impression

7. 8.

Nationality Gender Male Female

1. Post Code (See SEC A)

2. Preference for Exam City (Write Code) I. II. III.

9. All particulars given below should be maintained active till the end of selection process A) Address for Correspondence

3. Candidates Name as recorded in X Class Certificate:

(Leave one blank space between parts of the name)

4.

Fathers / Mothers / Husbands Name

(Leave one blank space between parts of the name)

______________________________ C/o: ________________________________ ADDRESS: ____________________________ ___________________________________ ___________________________________

NAME: STATE: PIN:

5. A) Date of Birth (as recorded in X Class Certificate) Y Y Y Y D D M M Age as on Closing Date B) (i) Are you seeking age relaxation? (ii) If yes, Attach proof on standard format 6. Category
(Please tick ( ) in the appropriate Box(es))

YY

MM

B) Permanent Address (Capital Letters) NAME:

YES

NO

Category
Unreserved (UR) Scheduled Caste (SC) Scheduled Tribe (ST) Other Backward Class (OBC)

Sub-category
Ex-Service Man (ESM) Govt. Servant (GS) Meritorious Sports Person (MSP) Widow/Divorcee PWD : Orthopaedically Handicapped (OH) Hearing Impaired (HI)

______________________________ C/o: ________________________________ ADDRESS: ____________________________ ___________________________________ ___________________________________

STATE: C) Telephone Nos. PIN:

Landline Mobile
D) E-mail _________________________@_____________________

Visually Impaired (VI) Minority Communities(OBC) (specify)...........................................

10. Educational Qualifications (Attach Self Attested Copy as Proof)

Examination Passed/ Appearing Main Subjects/ Trade University/ Board Year of Passing Duration of Course % of Marks Secured Division

X XII B.Sc./Diploma/ITI M.Sc/B.E./B.Tech Degree etc Others/ Pursuing 11. Fee Details A. Fees Paid Fees Exempted
(Attach appropriate proof, if exemption claimed)

B. Details of IPO Name of Post Office Serial No(s). of IPO Date of Issue Amount (`)

12.

Mention details if registered in Employment Exchange (Optional) Name & Address of Employment Exchange Registration No. Date of Registration

13. Employment Record in Govt./PSU/Autonomous Body etc. Name of Organization Post Held Pay Scale/Grade Pay Period From To Nature of Duties performed

14. Important Endorsements (A) (a) Mention Photo Identity Proof details (Attach Copy). The same is to be produced during the entire process of recruitment. (i) Type of ID Proof_______________ (ii) No._______________(iii) Date of Issue_____________(iv) Issued by____________ (b) For the Post of STA B & Technician A only (fill up as applicable) (i)Do you possess M.Sc./ B.Tech / B.E. Degree/Ph.D: Yes
]

No

If yes, specify :

(a) Degree & Subject ___________,___________ (b) Date of Admission ___________, (c) Date of completion___________ (ii) Are you pursuing M.Sc./B.E./B.Tech Degree/Ph.D: Do you have Driving License for LMV & HMV : Yes Yes No No If yes, Likely Date of completion_________ If yes, specify the following details

(c) For the post of Civilian Driver A & Fire Engine Driver only ( Must enclose copy of Driving License ) (i) Date of Issue ___________, (ii) Validity ___________, (iii) Issuing Authority and place _______________,__________ (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. Office Seal and Date Signature of Competent Authority 15. Any other relevant information .... 16. Declaration: I ... Son/Daughter/Wife of 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 it 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 : 18. (i) (ii) (iii) (iv) (v) (vi) (vii) (viii)

Date :

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

Note: Candidates are advised to retain the photocopy of their application form and copy of the Advertisement for claiming travel concession from Railways,
and also for references, if needed. Apply exactly on this format on A4 size (210X297mm) white plain paper.