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3/6/2015

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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