APPLICATION FORM FOR JUNIOR RESEARCH FELLOWSHIP IN CEPTAM (To be filled by the candidate in his/her own handwriting) Name of post Applied(with subject). _________________ , Advertisemnt No.-________________

Full Name in Block Letters

01.

(i) Fathers Name

02.

(ii) Husbands Name( For married women only)

3(a)

Gender :

Male

Female

Date of Birth (DD/MM/YYYY):

3(c)

Correspondence Address:

04.

Permanent Address:

05.

SC

ST

OBC

3(b) Category :

GEN

3(d) Age: ... yrs .... months (as on 08/08/2017)

Pincode:

Pincode:

06.

Contact Details: Phone(with STD code) : ___________________ Mobile: +91-________________________

E-mail ID: ________________________________________________

Educational Qualifications (From Matric/10^th/HSC onwards. Attested copies to be enclosed):

Month & Year

Division/

Percentage(%) /CGPA

Examination

Subject (s)

University or Board

Class/Grade

Passed

of passing

Experience (if any) Note: Attach sheets if required Name of Post

09.

Period of Service

Name of the

Job Description /Designation

(in Brief) Organization/Dept.

To

From

Whether Qualified UGC/CSIR/NET Examination:

YES

NO

10.

If yes, give details (proof to be enclosed) Year: ___________ Score : _____________ Have you ever been interviewed in DRDO,

YES

NO

11.

if so give details: _______________________________________________________________________________ Have you ever been debarred for recruitment examination by any Govt. agency

YES

NO

12.

if so give details: _______________________________________________________________________________

DECLARATION: I hereby declare that, the above furnished particulars are correct to the best of my knowledge and no information is suppressed. If at any time I am found to have concealed/distorted any information, my 13.

fellowship shall be liable to summary terminated without any prior notice. I am ready, to take up and discharge the duties assigned to me anywhere in India, as and when required.

For Office Use Only Place: ____________________