3/7/2015

CSIRUGCJRF/NETExam
(15J)

OnlineApplicationForm
JointCSIRUGCTestforJRFandEligibilityForLectureship,NET21062015
[CouncilofScientific&IndustrialResearchHRDGroup,ExaminationUnit]
1.RollNo(TobefilledbyOfficeOnly)

2.ApplicationNo.

15J633641

3.AppliedFor

:01JRF

4.Subject

:1CHECHEMICALSCIENCES

5.ExamCentre

:11HYDHYDERABAD

6.MeduimofNETExam(Asapplicable)

:02ENGLISH

7.CandidateName

:POOLARAMAMADDILETY

8.Sex

:MALE

9.Father/Mother/HusbandName

:FATHER>PYERRAMADDILETY

10.DateOfBirth

:08051992

11.AgeAsOn01012015

:22Y,7M,23D

12.Category

:SC

13.Physically/VisuallyHandicape(PH/VH)

:NA

14.IfVH,DoYouWantScribe'sHelp

:NA

15.WriteyournameandcompleteMailingAddress.
Name:

POOLARAMAMADDILETY

Address:

MANGAMPETA
OWKMANDAL
BANAGANAPALLI

City:

KURNOOL

Pin:

518124

State:

ANDHRAPRADESH

SignatureofCandidate>

16.PermanentAddress
Name

:POOLARAMAMADDILETY

Address

:MANGAMPETAVILLAGE
OWKMANDAL
BANAGANAPALLICity:KURNOOLPin:518124State:ANDHRAPRADESH

17.Email

:remo.maddilety142@gmail.com

Note:BachelorsdegreeholderswillnotbeeligibleforLectureship]
18.QualifyingDegree

:INTEGRATEDM.SCINCHEMISTRY

[CandidatesenrolledforM.Sc.orhavingcompleted10+2+3yearsofqualifyingexaminationasgivenincolumn
18,mayapplyunderResultAwaited(RA)category]
19.IfResultAwaited

:NO

20.YearOfAppearinginFinalExam

:NA(IfResultAwaited)

21.GivedetailofFinalExamResult(IfnotResultAwaited)
(a)YearOfPassing:2014(b)Division:FIRST(c)MarkObtained(%):65%
22.IfenrolledinMSPhDprogram

:NO

(a)Yearofenrollment

:NA

(b)Yearofpassingbachelordegree

:NA

(c)Division/Grade

:NA

(d)MarksObtained(%)

:0

http://59.163.216.82:8080/jrf/online/getview_form.jsp

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3/7/2015

CSIRUGCJRF/NETExam
ApplicationNo:

15J633641

23.Specialization:
(a)SpecializationCode:103(b)SpecializationSubjectName:ORGANICCHEMISTRY
24(a)University/InstituteCode

:221

(b)University/InstituteName

:SRIVENKATESWARAUNIVERSITY,TIRUPATI

DECLARATION
I,POOLARAMAMADDILETY,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)

NotApplicableForYouasYouhaveenteredRESULTAWAITEDas"NO"

25.ChallanDetail.
NameoftheBank
BranchCode
AmountinFigure(Rs.)
ChallanDate

:INDIANBANK
:00290
:250
:24/02/2015

Branch/City
JournalNo.
AmountinWord(Rs.)
Phone

:TIRUPATI
:3394731
:TWOHUNDREDFIFTY
:7382358817

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/getview_form.jsp

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3/7/2015

CSIRUGCJRF/NETExam

CutandPastefollowingaddressonyourownenvelop(5X11)

(ApplicationforJointCSIRUGCTestforJRF/LS(NET),June,2015)
[1CHE|15J633641|11HYD|02ENGLISH]

To,
Sr.ControllerofExaminations
ExaminationUnit,HumanResourceDevelopmentGroup
CSIRComplex,oppositeInstituteofHotelManagement,LibraryAvenue
Pusa,NewDelhi110012

http://59.163.216.82:8080/jrf/online/getview_form.jsp

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