CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s against the person
concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME TAMPOS
NAME EXTENSION (JR., SR) N/A
FIRST NAME DALTON

MIDDLE NAME CABOVERDE

3. DATE OF BIRTH
(mm/dd/yyyy) DEC. 21, 1969 16. CITIZENSHIP
✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH BABAK, DAVAO DEL NORTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female Philippines

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS ZONE-2

Widowed Separated House/Block/Lot No. Street
BRGY. VILLARICA, BABAK DIST.
Other/s:
Subdivision/Village Barangay

7. HEIGHT (m) 5'6" ISLAND GARDEN CITY OF SAMAL DAVAO DEL NORTE
City/Municipality Province
8. WEIGHT (kg) 62 ZIP CODE

18. PERMANENT ADDRESS ZONE-2

9. BLOOD TYPE B
House/Block/Lot No. Street
BRGY. VILLARICA, BABAK DIST.
10. GSIS ID NO. NONE
Subdivision/Village Barangay
ISLAND GARDEN CITY OF SAMAL DAVAO DEL NORTE
11. PAG-IBIG ID NO. 1900-0050-7756
City/Municipality Province
12. PHILHEALTH NO. 19-000124942-1 ZIP CODE 8118
13. SSS NO. NONE 19. TELEPHONE NO. NONE

14. TIN NO. 190-001-249 20. MOBILE NO. 09095073624

15. AGENCY EMPLOYEE NO. 00-088-079-015 21. E-MAIL ADDRESS (if any) doughthompsonz@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME TAMPOS 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) YNGWIE JOHANN DEE O. TAMPOS

FIRST NAME JENEFE N/A 7/28/2005

MIDDLE NAME OSORIO

OCCUPATION HOUSEKEEPER
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N.A
TELEPHONE NO. NONE
24. FATHER'S SURNAME TAMPOS
NAME EXTENSION (JR., SR)
FIRST NAME PANFILO (DECEASED) N/A

MIDDLE NAME NACUA

25. MOTHER'S MAIDEN NAME MAGHINAY
SURNAME TAMPOS
FIRST NAME GLORIA (DECEASED)
MIDDLE NAME CABOVERDE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
UNITS ACADEMIC
LEVEL (Write in full) EARNED
GRADUATED
HONORS
(Write in full) (if not graduated) RECEIVED
From To

ELEMENTARY MAMBAGO-B ELEM. SCHOOL PRIMARY EDUCATION 1977 1982 GRADUATED 1982 N/A
VOCATIONAL /
SECONDARY DINAGAT MUNICIPAL HIGH SCHOOL HIGH SCHOOL 1982 1986 GRADUATED 1986 N/A

N/A

TRADE BACHELOR OF SCIENCE IN

COLLEGE UNIVERSITY OF SOUTHEASTERN PHILS.
ELEMENTARY EDUCATION
1986 1993 GRADUATED 1993 N/A
COURSE
GRADUATE STUDIES N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE August 27, 2019
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

PRC BOARD FOR PROFESSIONALTEACHERS 76.60% 8/24/1996 Davao City 0988251 ###

CSC POLICE OFFICER I (ENT) 80.84% 11/10/1996 Davao City N/A

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. GOV'T
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)

8/1/2017 PRESENT SENIOR POLICE OFFICER 3 PHILIPPINE NATIONAL POLICE P 34, 761.00 18 PERMANENT YES

7/1/2014 7/31/2017 SENIOR POLICE OFFICER 2 PHILIPPINE NATIONAL POLICE P 23,513.00 18-3 PERMANENT YES

12/31/2011 06/31/2014 SENIOR POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE P 21,771.00 16-3 PERMANENT YES

1/1/2009 12/30/2011 POLICE OFFICER 3 PHILIPPINE NATIONAL POLICE P 16,966.00 14-2 PERMANENT YES

8/31/2004 12/31/2008 POLICE OFFICER 2 PHILIPPINE NATIONAL POLICE P 9,688.00 12-1 PERMANENT YES

9/16/1998 8/30/2004 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE P 5,000.00 10-1 PERMANENT YES

(Continue on separate sheet if necessary)

SIGNATURE DATE August 27, 2019
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) NUMBER OF HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
From To

N/A

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)
INCLUSIVE DATES OF
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
REGIONAL TRAINING CENTER 11,
PUBLIC SAFETY SENIOR LEADERSHIP COURSE 9/5/2016 12/27/2016 560 SUPERVISORY MINTAL, DAVAO CITY

FIELD TRAINING OFFICER'S DEVELOPMENT PROGRAM 1/14/2016 1/29/2016 120 TECHNICAL REGIONAL SPECIAL TRAINING UNIT, POLICE REGIONAL OFFICE 11
US-DEPARTMENT OF JUSTICE
(INTERNATIONAL CRTMINAL
TRAIN THE TRAINER HUMAN RIGHTS COURSE 6/29/2015 7/10/2015 80 TECHNICAL INVESTIGATIVE TRAINING ASSISTANCE
US-DEPARTMENT
PROGRAM OF JUSTICE
(INTERNATIONAL CRTMINAL
INSTRUCTOR DEVELOPMENT COURSE 5/9/2011 5/20/2011 56 TECHNICAL INVESTIGATIVE TRAINING ASSISTANCE
PROGRAM
REGIONAL TRAINING SCHOOL 11,
PUBLIC SAFETY JUNIOR LEADERSHIP COURSE 8/25/2009 1/25/2010 720 SUPERVISORY MINTAL, DAVAO CITY
PNP MASSCOM, DAVAO NORTE POLICE
MORAL RECOVERY PROGRAM 7/2/2008 7/3/2008 16 TECHNICAL PROVINCIAL OFFICE, POLICE REGIONAL
OFFICE
PHILIPPINE 11 NATIONAL POLICE CRIME
LABORATORY AND JAPAN
SCI ENTIFIC METHOD OF PROCESSING FINGERPRINT AND CRIME SCENE INVEST. 12/5/2006 12/7/2006 27 TECHNICAL INTERNATIONAL COOPERATION AGENCY,
PRO 11
DIRECTORATE FOR HUMAN RESOURCE
POST BLAST INVESTIGATION (PBI) 11/7/2005 11/24/2005 120 TECHNICAL AND DOCTRINE DEVELOPMENT,
REGIONAL TRAINING SCHOOL 11
REGIONAL SPECIAL TRAINING UNIT 11,
PNP-SPECIAL COUNTER INSURGENCY OPERATION UNIT TRAINING 12/16/2002 2/28/2003 392 TECHNICAL POLICE REGIONAL OFFICE 11
11TH EXPLOSIVE ORDNANCE DISPOSAL
EXPLOSIVE ORDNANCE RECONNAISANCE AGENT COURSE 4/1/2002 4/15/2002 80 TECHNICAL TEAM, REGIONAL SPECIAL TRINING
UNIT, POLICE REGIONAL
DIRECTORATE OFFICE 11 &
FOR INVESTIGATION
DETECTIVE MANAGEMENT, REGIONAL
CRIMINAL INVESTIGATION AND DETECTIVE DEVELOPMENT COURSE 7/27/2001 9/28/2001 300 TECHNICAL INTELLEGENCE & INVESTIGATION DIV.
PRO 11

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
full)

DRIVING N/A SIGMA LAMBDA PHI FRAT/SOR

COMPUTER LITERATE

BASKETBALL (HOBBIES)

(Continue on separate sheet if necessary)

SIGNATURE DATE August 27, 2019

CS FORM 212 (Revised 2017), Page 3 of 4
 34. Are you related by consanguinity or affinity to the appointing or recommending authority, or to the
chief of bureau or office or to the person who has immediate supervision over you in the Office,
Bureau or Department where you will be apppointed,
a. within the third degree? YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
If YES, give details:
35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
________________________________
YES ✘ NO
b. Have you been criminally charged before any court?
If YES, give details:
Date Filed:
________________________________
________________________________
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation YES ✘ NO
by any court or tribunal?
If YES, give details:
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, ________________________________
YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except ________________________________
YES ✘ NO
Barangay election)? If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the YES ✘ NO
last election to promote/actively campaign for a national or local candidate? If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country? YES ✘ NO
If YES, give details (country):

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA
7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:
a. Are you a member of any indigenous group? YES ✘ NO
If YES, please specify:
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No:
41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
NAME ADDRESS TEL. NO.
ID picture taken within
PCOL NOEL C ASUMEN IGCSPS 0921-538-4225 the last 6 months
3.5 cm. X 4.5 cm
VICE MAYOR RICHARD GUINDOLMAN IGCSPS (passport size)

With full and handwritten

PCAPT IAN JAMES S ACAL BABAK DIST., IGCS 0942-098-6707 name tag and signature over
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Computer generated
or photocopied picture
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein. is not acceptable
I agree that any misrepresentation made in this document and its attachments shall cause the filing of PHOTO
administrative/criminal case/s against me.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of Issuance
Government Issued ID: PNP ID

ID/License/Passport No.: 18B070093 Signature (Sign inside the box)

August 27, 2019
Date/Place of Issuance: 12/21/2021 / Camp, Crame, Q.C.
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 21st day of January 2019 affiant exhibiting his/her validly issued government ID as indicated above.

PCOL REY A DELOS REYES

CHIEF OF POLICE

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4