90109035484 ApplicationForm
ONLINE APPLICATION FORM
Advt. No. CEPTAM - 07
DRDO ENTRY TEST - 2014
Closing Date - 17th Oct 2014
For Office Use Only :
ONLINE APPLICATION NUMBER : 90109035484
Printed On Date :14 / 10 / 2014
9:2:38
8. Nationality : INDIAN
9. Willing to serve in Remote Area :YES
10. Gender :Male [ Y ] Female [ ]
1. POST CODE
STA'B'-[0109-ELECTRONICS OR ELECTRONICS &
COMMUNICATION OR ELECTRONICS &
TELECOMMUNICATION]
2. Preference For Exam City
I. 20-PATNA
II. 16-KANPUR
III. 10-GORAKHPUR
3. Candidate's Name as Recorded in X Class Certificate
AJAY KUMAR MISHRA
4. Father's Name
JAINATH MISHRA
5. Mother's Name
MALTI MISHRA
6. Date of Birth (as recorded in X Class Certificate)
19 / 07 / 1987
7. a) Category
[Y]
[ ]
Unreserved (UR)
Scheduled Tribe (ST)
[ ]
[ ]
Scheduled Caste (SC)
Other Backward Class
(OBC)
[ ]
[ ]
Govt. Servant (GS)
Widow/Divorcee
11. Contact Details (Note : All particulars given below in the head should be maintained active till the end of selection process) a ) Address for Correspondence
Name : MR. AJAY KUMAR MISHRA
C/O : SRI JAINATH MISHRA
QTR NO- I-692
HINDALCO COLONY
City/State: RENUKOOT , UTTAR PRADESH
Pincode: 231217 , Landline No: b ) Permanent Address
Name : MR. AJAY KUMAR MISHRA
C/O
SRI JAINATH MISHRA
QTR NO- I-692
HINDALCO COLONY
City/State: RENUKOOT , UTTAR PRADESH
Pincode: 231217 , Landline No:
7. b) Sub-Category
[ ]
[ ]
Ex-Service Man (ESM)
Meritorious Sports
Person (MSP)
[ ]
Persons with Disability (PWD)
[ ]
Orthopaedically
Handicapped (OH)
Visually Impaired (VI)
[ ]
[ ]
c ) Mobile No
+91 - 8601870174 d ) Email ajay.kt.mishra@gmail.com Hearing Impaired (HI)
12. a) Educational Qualification (Mention all completed/result awaited/appearing)
Qualification
X
XII
ITI
B.Sc
Diploma
Main Subjects / Trade
(Specify Subject / Trade as mentioned on the
Certificate / Degree of
EQR)
NA
PCM
ELECTRONICS
ENGINEERING
University / Board
Year of
Passing
Duration of Course
(In years)
UP BOARD
UP BOARD
2003
2005
NA
2
BTE UP
2008
3
Maximum
Marks
Advt. No. CEPTAM - 07
DRDO ENTRY TEST - 2014
Closing Date - 17th Oct 2014
For Office Use Only :
ONLINE APPLICATION NUMBER : 90109035484
Printed On Date :14 / 10 / 2014
9:2:38
8. Nationality : INDIAN
9. Willing to serve in Remote Area :YES
10. Gender :Male [ Y ] Female [ ]
1. POST CODE
STA'B'-[0109-ELECTRONICS OR ELECTRONICS &
COMMUNICATION OR ELECTRONICS &
TELECOMMUNICATION]
2. Preference For Exam City
I. 20-PATNA
II. 16-KANPUR
III. 10-GORAKHPUR
3. Candidate's Name as Recorded in X Class Certificate
AJAY KUMAR MISHRA
4. Father's Name
JAINATH MISHRA
5. Mother's Name
MALTI MISHRA
6. Date of Birth (as recorded in X Class Certificate)
19 / 07 / 1987
7. a) Category
[Y]
[ ]
Unreserved (UR)
Scheduled Tribe (ST)
[ ]
[ ]
Scheduled Caste (SC)
Other Backward Class
(OBC)
[ ]
[ ]
Govt. Servant (GS)
Widow/Divorcee
11. Contact Details (Note : All particulars given below in the head should be maintained active till the end of selection process) a ) Address for Correspondence
Name : MR. AJAY KUMAR MISHRA
C/O : SRI JAINATH MISHRA
QTR NO- I-692
HINDALCO COLONY
City/State: RENUKOOT , UTTAR PRADESH
Pincode: 231217 , Landline No: b ) Permanent Address
Name : MR. AJAY KUMAR MISHRA
C/O
SRI JAINATH MISHRA
QTR NO- I-692
HINDALCO COLONY
City/State: RENUKOOT , UTTAR PRADESH
Pincode: 231217 , Landline No:
7. b) Sub-Category
[ ]
[ ]
Ex-Service Man (ESM)
Meritorious Sports
Person (MSP)
[ ]
Persons with Disability (PWD)
[ ]
Orthopaedically
Handicapped (OH)
Visually Impaired (VI)
[ ]
[ ]
c ) Mobile No
+91 - 8601870174 d ) Email ajay.kt.mishra@gmail.com Hearing Impaired (HI)
12. a) Educational Qualification (Mention all completed/result awaited/appearing)
Qualification
X
XII
ITI
B.Sc
Diploma
Main Subjects / Trade
(Specify Subject / Trade as mentioned on the
Certificate / Degree of
EQR)
NA
PCM
ELECTRONICS
ENGINEERING
University / Board
Year of
Passing
Duration of Course
(In years)
UP BOARD
UP BOARD
2003
2005
NA
2
BTE UP
2008
3
Maximum
Marks