Application Form
Advt. No. CEPTAM- DRDO ENTRY TEST-2018 Crucial date of Eligibility-29-
09/STA-B 08-2018
For Office Use Only
Online Application Number:
901190511535
Generated On Date:
11/09/2018
8. Nationality: INDIAN
9. Identity Proof
Type: Aadhaar Card No.
7983 0365 9084
1. Post Code & Post Name: [STA-B]-0119 10. Gender: Male
Physics
11. Contact Details:
2. Exam City Preference:37-PATNA,23-
JAMSHEDPUR,12-GORAKHPUR
a) Correspondence
Address: BADHIYA
3. Candidate’s Name: RAJESH ROUSHAN
District: Nalanda City:
4. Father’s Name: RAM KISHOR PRASAD
NALANDA
5. Mother’s Name: BIDYA DEVI
State: BIHAR Pincode:
6. Date of Birth: 15-09-1996
811104
Age as on Crucial Date: 21Y,11M,14D
(if Permanent Address same
7. a) Category
as Correspondence Address)
Unreserved(UR) Scheduled Caste (SC)
Scheduled Tribe (ST) OBC (Creamy
b) Permanent Address:
Layer)
BADHIYA
OBC (Non-Creamy Layer)
District: Nalanda City:
(if ST/SC/OBC-NCL) NALANDA
Certificate no: C/18/01446 Date of issue: 08- State: BIHAR Pincode:
05-2018 811104
c) Mobile No: 7903878708
d) Alternate No: 9718750766
e) Email ID:
[email protected] 12. Essential Qualifications
a) Do you possess EQR as per CEPTAM-09/STA-B Advt. (Diploma /B.Sc.) as on
crucial date of eligibility: Yes No
b) Do you possess B.Sc./Diploma/Both : B.Sc. Diploma Both(Diploma and
B.Sc.)
Mode of Max. Marks/ % of
Main University/ Year of
Qualification Degree/ Roll No. Marks/ CGPA Marks
Subject Board Passing
Qualification CGPA obtained Secured
X Regular MATHS 005 BSEB 2011 500 387.00 77.40
XII Regular SCIENCE 10409 BSEB 2013 500 351.00 70.20
MAGADH
B.Sc Regular PHYSICS 1632099951 2016 800 485.00 60.60
UNIVERSITY
c) Subject mentioned on EQR: PHYSICS HON
d) Higher Qualification (B.E., B.Tech, M.Sc, M.Tech, Ph.D., etc)
Have you Completed YES NO
Are you Pursuing YES NO
Degree Likely Date of Completion Degree Likely Date of Completion
NA NA NA NA
13. a) Details of Application Fee of Rs. 100/- Paid (If not exempted as per Govt. rules)
Payment Fee Payment
Payment ID Transaction ID Status
Method Amount Date
DC 100 11/09/2018 APTC000141815720180911103912 20180911111212800110168272336324487 PAID
14. Physical Measurements:
a) Height (cm): 168.50 b) Weight(kg): 52.00 c) Visible Identification Mark: MOLE
ON THE LEFT NICK
15. Special Categories (if any) :
a) Do you belong to Minority community: Yes No
b) Domiciled in J&K during 01/01/1980 to 31/12/1989 : Yes No
c) Defence Personnel with Disability: YES NO
Have you already secured employment in civil side under Central Government on
regular basis after availing the benefits of reservation given to Ex-servicemen for
re-employment? YES NO
16.Posting Preference
Preference 1 2 3 4 5 6 7
Location(City Code) (D2) (C1) (D1) (V1) (P2) (H2) (K2)
17.List of Documents Uploaded
10th class or equivalent Certificate , EQR Certificate, Caste Certificate
I hereby give my consent to disclose my particulars, score and rank of examination
publically (refer 5.2 of CEPTAM-09/STA-B Advertisement) on the website. Yes
No
18. Declaration
I RAJESH ROUSHAN son/daughter of RAM KISHOR PRASAD hereby declare that
a) I have read and understand 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.
19. Required at the time of document verification, if shortlisted
Place:
Date:
a) Left Hand Thumb Impression b) Signature of Candidate
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 Detailed 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
Online Application Number: 901190511535 , Generated on 11/09/2018
